Laparoscopic versus open appendectomy in adults and children: A meta-analysis of randomized controlled trials

Abstract

Objective: The aim of this study was to evaluate the differences of laparoscopic appendectomy (LA) versus open appendectomy (OA) in adults and children. Methods: Randomized controlled trials (RCTs) comparing LA and OA in adults and children between January 1992–March 2016 were included in this study. A meta-analysis was performed to evaluate wound infection, intra-abdominal abscess, postoperative complications, reoperation rate, operation time, postoperative stay, and return to normal activity. Result: Thirty-three studies including 3642 patients (1810 LA, 1832 OA) were included. Compared with OA, LA in adults was associated with lower incidence of wound infection, fewer postoperative complications, shorter postoperative stay, and earlier return to normal activity, but a longer operation time. There was no difference in levels of intra-abdominal abscess and reoperation between the groups. Subgroup analysis in children did not reveal significant differences between the two techniques in wound infection, postoperative complications, postoperative stay, and return to normal activity. Conclusion: LA in adults is worth recommending as an effective and safe procedure for acute appendicitis, and further high-quality randomized trials comparing the two techniques in children are needed.