title: Interventions to optimize recovery after laparoscopic appendectomy: a scoping review.
abstract: No enhanced recovery after surgery protocol has been published for laparoscopic appendectomy. This was a review of evidence-based interventions that could optimize recovery after appendectomy.
  
  
  
  Interventions for the review Clinical pathway, fast-track or enhanced recovery protocols; needlescopic approach; single incision laparoscopic (SIL) approach; natural orifice transluminal endoscopic surgery (NOTES); regional nerve blocks; intraperitoneal local anaesthetic (IPLA); drains. Data sources MEDLINE, EMBASE, the Cochrane Library, and the Web of Science Core Collection. Study eligibility criteria Randomized controlled trial (RCT); prospective evaluation with historical controls for studies assessing clinical pathways/protocols. Participants People undergoing laparoscopic appendectomy for acute appendicitis. Study appraisal and synthesis methods Meta-analysis, random effects model.
  
  
  
  Clinical pathways for laparoscopic appendectomy were safe in selected patients, but may be associated with a higher readmission rate. Needlescopic surgery offered no recovery advantage over traditional laparoscopic appendectomy. SIL afforded no recovery advantage over conventional laparoscopic surgery, but may increase operative time in children. The search found no RCT on NOTES appendectomy. Transversus abdominis plane blocks did not significantly reduce pain after laparoscopic appendectomy. IPLA should be considered in laparoscopic appendectomy; studies in paediatric surgery are needed. The search found no RCT on the use of drains in appendectomy.
  
  
  
  This review identified gaps in the literature on optimizing recovery after laparoscopic appendectomy and found the need for more randomized controlled trials on regional anaesthesia and intraperitoneal local anaesthesia in children.
authors.affiliation: Department of Surgery, Starship Hospital, Park Road, Grafton, Private Bag 92024, Auckland, 1142, New Zealand. jham011@aucklanduni.ac.nz.|Department of Surgery, The University of Auckland, Auckland, New Zealand. jham011@aucklanduni.ac.nz.
authors.forename: James K
authors.initials: JK
authors.lastname: Hamill
authors.affiliation: Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
authors.forename: Jamie-Lee
authors.initials: JL
authors.lastname: Rahiri
authors.affiliation: School of Medicine, The University of Auckland, Auckland, New Zealand.
authors.forename: Gamage
authors.initials: G
authors.lastname: Gunaratna
authors.affiliation: Department of Surgery, The University of Auckland, Auckland, New Zealand.|Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D019091:Critical Pathways; D006801:Humans; D010535:Laparoscopy; D015233:Models, Statistical; D019990:Perioperative Care / Q000379:methods*; D016896:Treatment Outcome
keywords: Analgesia; Appendectomy; Laparoscopy; Length of stay; Postoperative pain