A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis

OBJECTIVE: TO determine if ally significant differences exist between lapar oscopic appendectomy (LA) and open appendectomy (OA). DESIGN: A meta-analysis of randomized controlled trials (RCTs) comparing LA to OA. DATA SOURCES: An extensive literature search was conducted for appropriate articles published between January 1990 and March 1997. Articles were initi ally retrieved through MEDLINE with MeSH terms "appendicitis" or "appendect omy" and "laparoscopy." Additional methods included cross-referencing bibli ographies of retrieved articles, hand searching abstracts from relevant mee tings and consultation with a content expert. STUDY SELECTION: Only RCTs published in English in which patients had a pre operative diagnosis of acute appendicitis were included. DATA EXTRACTION: The outcomes of interest included operating time, hospital stay, readmission rates, re rum to normal activity and complications. The Cochrane Collaboration Review Manager 3.0 was used to calculate odds ratios (OR), weighted mean differences (WMD) and 95% confidence intervals (Ci). T he random-effects model was used for statistical analysis. DATA SYNTHESIS: Twelve trials met the inclusion criteria. Because there wer e insufficient data in some trials, operating time, hospitalization and ret urn to work were assessed in only 8 trials. Mean operating time was signifi cantly longer with LA (WMD 18.10 minutes, 95% CI 12.87 to 23.15 minutes). T here were fewer wound infections in LA (OR 0.40, 95% CI 0.24 to 0.69), but no significant differences in intra-abdominal abscess rates (OR 1.94, 95% C I 0.68 to 5.58). There was no significant difference in the mean length of hospital stay (WMD -0.16 days, 95% CI -0.44 to 0.15 days) or readmission ra tes (OR 1.16, 95% CI 0.54 to 2.48). However, the return to normal activity was significantly earlier with LA (WMD -5.79 days, 95% CI -7.38 to -4.21 da ys). Sensitivity analyses did not affect the results. CONCLUSION: This meta-analysis suggests that operating room time is signifi cantly longer, hospital stay is unchanged but return to normal activities i s significantly earlier with LA.