Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis (original) (raw)

Background 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. Methods 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. Results 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). Conclusion 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. Keywords Complicated appendicitis • Laparoscopic appendectomy • Open appendectomy • Intraabdominal abscess Acute appendicitis (AA) is a common condition requiring surgical intervention in the pediatric population, with an incidence rate of 9.4 cases per 10,000 person-years [1]. Due to increasing usage of specific diagnostic techniques such as Computed Tomography (CT), there is an increasing trend in the annual rate of AA [2]. Complicated appendicitis (CA), defined as histologically or intraoperatively diagnosed gangrenous appendicitis (GA), perforated appendicitis (PA), suppurative appendicitis (SA), and appendicitis with an abscess or periappendicular mass, represents 28% of all cases [2]. Both the historical and recent epidemiological data have also shown that among all age groups, AA occurs most frequently in pediatric patients [2, 3] while CA has a positive correlation with younger age groups [4]. Before 1983-the year which the first laparoscopic appendectomy (LA) was reported by Semm [5], surgical treatment for AA solely comprised open appendectomy (OA) that was initially described by McBurney in 1894 [6]. In the last 20 years, LA is increasingly adopted over OA due to multiple benefits associated with minimally invasive surgery, such as lower rate of surgical site infection (SSI),