Laparoscopic versus conventional appendectomy - a meta-analysis of randomized controlled trialsReport as inadecuate




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BMC Gastroenterology

, 10:129

First Online: 03 November 2010Received: 30 June 2010Accepted: 03 November 2010

Abstract

BackgroundAlthough laparoscopic surgery has been available for a long time and laparoscopic cholecystectomy has been performed universally, it is still not clear whether open appendectomy OA or laparoscopic appendectomy LA is the most appropriate surgical approach to acute appendicitis. The purpose of this work is to compare the therapeutic effects and safety of laparoscopic and conventional -open- appendectomy by means of a meta-analysis.

MethodsA meta-analysis was performed of all randomized controlled trials published in English that compared LA and OA in adults and children between 1990 and 2009. Calculations were made of the effect sizes of: operating time, postoperative length of hospital stay, postoperative pain, return to normal activity, resumption of diet, complications rates, and conversion to open surgery. The effect sizes were then pooled by a fixed or random-effects model.

ResultsForty-four randomized controlled trials with 5292 patients were included in the meta-analysis. Operating time was 12.35 min longer for LA 95% CI: 7.99 to 16.72, p < 0.00001. Hospital stay after LA was 0.60 days shorter 95% CI: -0.85 to -0.36, p < 0.00001. Patients returned to their normal activity 4.52 days earlier after LA 95% CI: -5.95 to -3.10, p < 0.00001, and resumed their diet 0.34 days earlier95% CI: -0.46 to -0.21, p < 0.00001. Pain after LA on the first postoperative day was significantly less p = 0.008. The overall conversion rate from LA to OA was 9.51%. With regard to the rate of complications, wound infection after LA was definitely reduced OR = 0.45, 95% CI: 0.34 to 0.59, p < 0.00001, while postoperative ileus was not significantly reducedOR = 0.91, 95% CI: 0.57 to 1.47, p = 0.71. However, intra-abdominal abscess IAA, intraoperative bleeding and urinary tract infection UIT after LA, occurred slightly more frequentlyOR = 1.56, 95% CI: 1.01 to 2.43, p = 0.05; OR = 1.56, 95% CI: 0.54 to 4.48, p = 0.41; OR = 1.76, 95% CI: 0.58 to 5.29, p = 0.32.

ConclusionLA provides considerable benefits over OA, including a shorter length of hospital stay, less postoperative pain, earlier postoperative recovery, and a lower complication rate. Furthermore, over the study period it was obvious that there had been a trend toward fewer differences in operating time for the two procedures. Although LA was associated with a slight increase in the incidence of IAA, intraoperative bleeding and UIT, it is a safe procedure. It may be that the widespread use of LA is due to its better therapeutic effect.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-230X-10-129 contains supplementary material, which is available to authorized users.

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Author: Xiaohang Li - Jialin Zhang - Lixuan Sang - Wenliang Zhang - Zhiqiang Chu - Xin Li - Yongfeng Liu

Source: https://link.springer.com/







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