Laparoscopic vs. open appendectomy: a simple answer for complicated appendicitis? | 40 identified studies | 4 randomized control trials | 36 case-control trials | 6243 TOTAL PATIENTS (< 18 YEARS OLD) | 2846 laparoscopic appendectomies (LA) | 3397 open appendectomies (OA) | Wound infections → LA < OA | Operative time → OA < LA | Length of stay → LA < OA | INTRAABDOMINAL ABSCESS (P=0.87) | SURGICAL DRAIN PLACEMENT (P=0.37) | NO DIFFERENCE | Conclusion: Laparoscopic appendectomy for complicated appendicitis has a low complication profile with shorter LOS. | https://pubmed.ncbi.nlm.nih.gov/34332757 | Source: Neogi et. al. Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India | @NikhilShah_MD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Laparoscopic versus open appendicectomy for complicated appendicitis in children: A systematic review and meta-analysis
Infographic · Mar 2022 · 1 min read
In brief
In brief
This systematic review of 40 studies (6,243 pediatric patients) demonstrates that laparoscopic appendectomy for complicated appendicitis results in shorter hospital stays, lower surgical site infection rates, and fewer overall complications compared to open surgery, despite longer operative times. The findings support laparoscopy as the preferred approach for children with complicated appendicitis.
- Laparoscopic appendectomy in complicated pediatric appendicitis reduces surgical site infections and overall complications versus open approach.
- Hospital length of stay is shorter with laparoscopic versus open appendectomy in children with complicated appendicitis.
- Intraabdominal abscess rates are similar between laparoscopic and open approaches, contradicting historical concerns about laparoscopy.
- Laparoscopic appendectomy enables faster return to oral intake and reduces analgesic requirements despite longer operative time.
- Meta-analysis of 40 studies supports laparoscopy as preferred approach for complicated appendicitis in pediatric patients.
Written by the GCMD Library team from the infographic.
The infographic uses a teal, dark green, and yellow color scheme with a hierarchical flow chart at the top showing patient distribution. Key findings are highlighted in yellow text against dark backgrounds. Simple illustrations include stacked papers, cartoon children, and a surgeon icon. Statistical comparisons are presented with arrow notation, and the bottom section uses large text to emphasize 'NO DIFFERENCE' for specific outcomes.
Background: Laparoscopic appendectomy (LA) is the preferred approach in uncomplicated appendicitis. However, in patients with complicated appendicitis (CA), the best approach is still unclear though laparoscopy is being increasingly preferred over open appendicectomy (OA) nowadays.
Aim: To comprehensively review the current literature and compare the associations of LA and OA concerning various postoperative outcomes in order to determine the best approach for children with CA.
Methods: The PRISMA guidelines were adhered to and an electronic database search was extensively performed. Data analysis, including subgroup analysis of randomized-control trials, was performed using RevMan 5.3. Methodological and statistical heterogeneity, as well as publication bias of the included studies, were assessed.
Results: Four randomized controlled trials (266 LA versus 354 OA) and thirty-six case-controlled trials (2580 LA versus 3043 OA) were included in the analysis. Compared to OA, LA has a shorter length of stay, a lower rate of surgical site infection as well as a significantly lower overall complication rate. The rates of intraabdominal abscess formation, post-operative fever, pneumonia and ileus are similar in the two groups. So are the rates of readmissions and reoperations. LA was also shown to have a shorter time taken to oral intake and a lesser requirement of analgesics as well as intravenous antibiotics. Operative time for OA was found to be significantly shorter than that for LA.
Conclusion: This meta-analysis objectively demonstrates that laparoscopy has a better overall complication profile compared to OA and should be the procedure of choice in children with complicated appendicitis.