LAPAROSCOPIC VS CONVENTIONAL APPENDECTOMY - A METAANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Aim: To compare the effectiveness and safety of laparoscopic and conve ntional ''open'' appendectomy in the treatment of acute appendicitis. Methods: Meta-analysis of randomised controlled trials available by Ma y 1998 that compared both techniques. Within each trial and for each o utcome an effect size was calculated; the effect sizes were then poole d by a random-effects model. Results: We summarised outcome data of 28 77 patients included in 28 trials. Operating time was +16 min (95% con fidence interval +12-20 min) longer for laparoscopic appendectomy. Ove rall complication rates were comparable, but wound infections were def initely reduced after laparoscopy [rate difference -4.2%, (-2.3% to -6 .1%)]. Intra-abdominal abscesses, however, occurred slightly more freq uently [+0.9%, (-0.4% to +2.3%)]. Hospital stay after laparoscopic app endectomy was 15 h (8-23 h) shorter, and patients returned to full fit ness or work 7 days (5-9 days) earlier. Pain intensity on day 1 was sl ightly less. Heterogeneity was present for some outcome measures due t o methodological differences among the primary studies. Conclusion: La paroscopic appendectomy reduces wound infections and eases postoperati ve recovery. Nevertheless, the various differences among the primary s tudies and their partly flawed methodology make it difficult to genera lise from these findings.