title: Is laparoscopic appendectomy feasible for complicated appendicitis ?A systematic review and meta-analysis.
abstract: BACKGROUND
  laparoscopic appendectomy(LA) has proved to be a safe alternative to open appendectomy(OA) in uncomplicated appendicitis; however, the feasibility of LA for complicated appendicitis(CA) has not been conclusively determined.
  
  
  OBJECTIVE
  To assess the feasibility and safety of LA for CA through a systematic review and meta-analysis.
  
  
  METHODS
  A literature search in PubMed, Embase, Cochrane Library, and web of Science was performed for eligible studies published from the inception of the databases to January 2016. All studies comparing LA and OA for CA were reviewed. After literature selection, data extraction and quality assessment were performed by two reviewers independently, and meta-analysis was conducted using Revman software, vision 5.2.
  
  
  RESULTS
  Two randomized controlled trials (RCTs) and 14 retrospective cohort studies(RCSs) were finally identified. Our meta-analysis showed that LA for CA could reduce the rate of surgical site infections (SSIs) (OR = 0.28; 95% CI: 0.25 to0.31, P < 0.00001), but LA did not increase the rate of postoperative intra-abdominal abscess(IAA) (OR = 0.79; 95% CI: 0.45 to 1.34, P = 0.40). The results showed that the operating time in the LA groups was much longer than that in the OA groups (WMD = 13.78, 95% CI: 8.99 to 18.57, P < 0.00001). However, the length of hospital stays in the LA groups were significantly shorter than those in the OA groups (WMD = -2.47, 95%CI: -3.75 to -1.19, P < 0.0002), and the time until oral intake(TTOI) was much earlier in the LA groups than in the OA groups (WMD = -0.88, 95% CI: -1.20 to -0.55, P < 0.00001). No significant difference was observed in the times of postoperative analgesia between the two groups(P > 0.05).
  
  
  CONCLUSIONS
  LA was feasible and safe for complicated appendicitis, and it not only could shorten the hospital stays and the time until oral intake, but it could also reduce the risk of surgical site infection.
authors.affiliation: Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China. Electronic address: 774242785@qq.com.
authors.forename: Man-Cheng
authors.initials: MC
authors.lastname: Yu
authors.affiliation: Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China.
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Feng
authors.affiliation: Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Fan
authors.affiliation: Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China.
authors.forename: Hong-Tao
authors.initials: HT
authors.lastname: Cheng
authors.affiliation: Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China.
authors.forename: Juan
authors.initials: J
authors.lastname: Xu
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome
keywords: Complicated appendicitis; Laparoscopic appendectomy