Laparoscopic versus open appendectomy: A metaanalysis

Background: There have been numerous retrospective and uncontrolled series of laparoscopic appendectomy (LA), as well as 16 prospective randomized studies published to date. Although most of these have concluded that the laparoscopic technique is as least as good as open appendectomy (OA), there has been considerable controversy as to whether LA is superior. To help clarify this issue, we performed a metaanalysis of the randomized prospective studies. Study Design: A metaanalysis of all formally randomized prospective trials of LA versus OA in adults. Results: A total of 1,682 patients were analyzed. When compared with OA, LA results in significantly less postoperative pain, earlier resumption of solid foods, a shorter hospital stay, and a faster return to normal activities. The wound infection rate in the LA patients is less than one half the rate in patients undergoing OA. LA, however, requires longer operating times and the incidence of intraabdominal abscess is higher, but this failed to reach statistical significance. There were no differences in complications or hospital charges. Conclusions: LA offers considerable advantages over OA, primarily because of its ability to reduce the incidence of mound infections and shorten recovery times. Its widespread acceptance should be considered. The trend toward increased intraabdominal abscess formation is worrisome, however, and demands further investigation. (C) 1998 by the American College of Surgeons.