LAPAROSCOPIC VERSUS OPEN APPENDECTOMY - A METAANALYSIS

Background: There have been numerous retrospective and uncontrolled se ries of laparoscopic appendectomy (LA), as well as 16 prospective rand omized studies published to date. Although most of these have conclude d that the laparoscopic technique is as least as good as open appendec tomy (OA), there has been considerable controversy as to whether LA is superior. To help clarify this issue, we performed a metaanalysis of the randomized prospective studies. Study Design: A metaanalysis of al l formally randomized prospective trials of LA versus OA in adults. Re sults: A total of 1,682 patients were analyzed. When compared with OA, LA results in significantly less postoperative pain, earlier resumpti on of solid foods, a shorter hospital stay, and a faster return to nor mal activities. The wound infection rate in the LA patients is less th an one half the rate in patients undergoing OA. LA, however, requires longer operating times and the incidence of intraabdominal abscess is higher, but this failed to reach statistical significance. There were no differences in complications or hospital charges. Conclusions: LA o ffers considerable advantages over OA, primarily because of its abilit y to reduce the incidence of mound infections and shorten recovery tim es. Its widespread acceptance should be considered. The trend toward i ncreased intraabdominal abscess formation is worrisome, however, and d emands further investigation. (C) 1998 by the American College of Surg eons.