Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis
- 293 Downloads
Acute appendicitis is a common condition in the pediatric population. In patients with uncomplicated appendicitis, laparoscopic appendectomy (LA) is preferred as compared to open appendectomy (OA). However, in patients with complicated appendicitis (CA), as defined as suppurative, gangrenous or perforated appendicitis, or appendicitis with periappendicular abscess formation, the decision to perform OA or LA remains unclear.
The PRISMA guidelines were adhered to. An electronic database search from 1997 to 2017 was performed using the Cochrane, Medline, PubMed, Scopus, Ovid, Embase, and Web of Knowledge databases. Data analysis, including subgroup analysis of randomized-control trials, was performed using RevMan 5.3. Assessment of methodological and statistical heterogeneity, as well as publication bias of the included studies, was performed.
Six randomized-control trials (296 LA versus 373 OA) and 33 case–control trials (3106 LA versus 4149 OA) were analyzed. Compared to OA, LA has a shorter length of stay (WMD = − 0.96, 95% CI − 1.47 to − 0.45) and a lower rate of surgical site infection (OR 0.37, 95% CI 0.25–0.54), although the rates of intraabdominal abscess formation were similar (OR 1.01, 95% CI 0.71–1.43). LA was also shown to have lower readmission rates, lower incidences of postoperative ileus or intestinal obstruction, lower incidence of reoperation, as well as a shorter time taken to oral intake. Operative time for OA was shorter than LA (WMD = 12.44, 95% CI 2.00–22.87).
While studies in the past have associated LA with higher rates of intraabdominal abscess in patients with CA, our meta-analysis has shown that they were similar. Considering this, together with other improved postoperative outcomes, LA should be the procedure of choice in pediatric patients presenting with CA.
KeywordsComplicated appendicitis Laparoscopic appendectomy Open appendectomy Intraabdominal abscess
There are no acknowledgements.
Compliance with Ethical Standards
Zhi Xuan Low, Glenn Kunnath Bonney, Jimmy Bok Yan So, Dale Lincoln Loh, and Jun Jie Ng have no conflicts of interest.
- 12.Dai L, Shuai J (2017) Laparoscopic versus open appendectomy in adults and children: a meta-analysis of randomized controlled trials. United Eur Gastroenterol J 5:542–553Google Scholar
- 13.Bennett J, Boddy A, Rhodes M (2007) Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutaneous Tech 17:245–255Google Scholar
- 14.Liu Z, Zhang P, Ma Y, Chen H, Zhou Y, Zhang M, Chu Z, Qin H (2010) Laparoscopy or not: a meta-analysis of the surgical effects of laparoscopic versus open appendicectomy. Surg Laparosc Endosc Percutaneous Tech 20:362–370Google Scholar
- 20.Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. The Cochrane database of systematic reviews, https://doi.org/10.1002/14651858.CD001546.pub3, October 12, 2010
- 21.Zhang S, Du T, Jiang X, Song C (2017) Laparoscopic appendectomy in children with perforated appendicitis: a meta-analysis. Surg Laparosc Endosc Percutaneous Tech 27:262–266Google Scholar
- 23.Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1. 0. The Cochrane Collaboration and John Wiley & Sons Ltd., England, pp 1–674Google Scholar
- 27.Khirallah MG, Eldesouki NI, Elzanaty AA, Ismail KA, Arafa MA (2017) Laparoscopic versus open appendectomy in children with complicated appendicitis. Ann Pediatr Surg 13:17–20Google Scholar
- 29.Oka T, Kurkchubasche A, Bussey J, Wesselhoeft C, Tracy T, Luks F (2004) Open and laparoscopic appendectomy are equally safe and acceptable in children. Surg Endosc Other Interv Tech 18:242–245Google Scholar
- 33.Li P, Han Y, Yang Y, Guo H, Hao F, Tang Y, Guo C (2017) Retrospective review of laparoscopic versus open surgery in the treatment of appendiceal abscess in pediatric patients: Laparoscopic versus open surgery for appendiceal abscess. Med 96:30Google Scholar
- 35.McKinlay R, Neeleman S, Klein R, Stevens K, Greenfeld J, Ghory M, Cosentino C (2003) Intraabdominal abscess following open and laparoscopic appendectomy in the pediatric population. Surg Endosc Other Interv Tech 17:730–733Google Scholar
- 37.Miyano G, Okazaki T, Kato Y, Marusasa T, Takahashi T, Lane GJ, Yamataka A (2010) Open versus laparoscopic treatment for pan-peritonitis secondary to perforated appendicitis in children: a prospective analysis. J Laparoendosc Adv Surg Tech 20:655–657Google Scholar
- 38.Nadler EP, Reblock KK, Qureshi FG, Hackam DJ, Gaines BA, Kane TD (2006) Laparoscopic appendectomy in children with perforated appendicitis. J Laparoendosc Adv Surg Tech 16:159–163Google Scholar
- 39.Nwokoma NJ, Swindells MG, Pahl K, Mathur AB, Minocha A, Kulkarni M, Tsang T (2009) Pediatric advanced appendicitis: open versus laparoscopic approach. Surg Laparosc Endosc Percutaneous Tech 19:110–113Google Scholar
- 42.Thambidorai C, Aman FY (2008) Laparoscopic appendicectomy for complicated appendicitis in children. Singap Med J 49:994–997Google Scholar
- 43.Tirabassi MV, Tashjian DB, Moriarty KP, Konefal SH, Courtney RA, Sachs BF (2004) Perforated appendicitis: is laparoscopy safe? J Soc Laparoendosc Surg 8:147Google Scholar
- 45.Yagmurlu A, Vernon A, Barnhart D, Georgeson K, Harmon C (2006) Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy. Surg Endosc Other Interv Tech 20:1051–1054Google Scholar
- 46.Bıçakcı Ü, Tander B, Günaydın M, Rızalar R, Aritürk E, Ayyıldız SH, Bernay F (2011) The comparison of open and laparoscopic appendectomy: is there any outcome difference between non-complicated and complicated appendicitis? Balkan Med J 28:304–306Google Scholar
- 49.Esposito C, Borzi P, Valla JS, Mekki M, Nouri A, Becmeur F, Allal H, Settimi A, Shier F, Sabin MG (2007) Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases. World J Surgery 31:750–755Google Scholar
- 58.Valla J, Steyaert H, Alain L (1996) Management of appendicular peritonitis in children: traditional surgery vs. laparoscopy. Retrospective comparative study of pediatric video surgery group. Int J Pediatr Surg Sci 10:13–16Google Scholar
- 61.Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, Stamos MJ (2012) Comparison of outcomes of laparoscopic versus open appendectomy in children: data from the Nationwide Inpatient Sample (NIS), 2006–2008. World J Surgery 36:573–578Google Scholar