A meta analysis of randomized controlled trials of laparoscopic versus conventional appendectomy

BACKGROUND: Despite many randomized controlled trials, the merits of laparo scopic appendectomy remain unclear. A meta-analysis may provide insights no t evident from any individual studies. DATA SOURCES: Systematic literature search yielded 17 trials (1,962 subject s) of true randomized design with usable statistical data comparing laparos copic and conventional appendectomy in adults. The effect sizes for operati ng time, hospitalization, postoperative pain, return to normal activity, wo und infection, and intra-abdominal abscess were calculated, using the rando m effects model to allow for heterogeneity. An estimate of the robustness o f all positive findings was also calculated. RESULTS: Modest but statistically significant effect sizes were found for f our of the six outcome measures. Laparoscopic appendectomy takes 31% longer to perform, but results in less post-operative pain, faster recovery (by 3 5%), and lower wound infection rates (by 60%). CONCLUSION: Laparoscopic appendectomy offers significant improvement in pos toperative outcomes at the cost of a longer operation. (C) 1999 by Excerpta Medica, Inc.