In the right lower part of the abdomen there is a small blind ending intestinal tube, called appendix. Inflammation of the appendix is called appendicitis and is usually acute in onset. Appendicitis is most frequent in children and young adults. Most cases require emergency surgery, in order to avoid rupture of the appendix into the abdomen. During the operation, called appendectomy, the inflamed appendix is surgically removed. The traditional surgical approach involves a small incision (about 5 cm or 2 inches) in the right lower abdominal wall. Alternatively, it is possible to perform the operation by laparoscopy. This operation, called laparoscopic appendectomy, requires 3 very small incisions (each about 1 cm or 1/2 inch). The surgeon then introduces a camera and some instruments into the abdomen and removes the appendix as in the conventional operation.
This review analysed 67 clinical studies, in which surgical technique (conventional open or laparoscopic) for each patient was determined by chance. The majority of studies were done on adults, but there were also 7 studies on children. The main advantages of laparoscopic over conventional appendectomy were reduced risk of wound infection, reduced postoperative pain, shorter hospital stay (-1 day), and more rapid return to normal activities. As disadvantages of laparoscopic appendectomy a longer duration of the operation (+10 minutes) and a higher rate of intraabdominal abscesses were identified. The results for children were similar to those seen in adults. An additional benefit of the laparoscopic approach is the possibility to inspect the inside of the abdomen. Especially in women of childbearing age, in whom many other conditions can mimic appendicitis, laparoscopy therefore reduces the risk of an unnecessary appendectomy.
In summary, laparoscopic surgery for suspected appendicitis has diagnostic and therapeutic advantages as compared to conventional surgery. However, conventional appendectomy should not be considered 'wrong', because the difference between the two techniques is rather small and strongly depends on patient characteristics and the treating surgeon's expertise.
In those clinical settings where surgical expertise and equipment are available and affordable, diagnostic laparoscopy and LA (either in combination or separately) seem to have various advantages over OA. Some of the clinical effects of LA, however, are small and of limited clinical relevance. In spite of the mediocre quality of the available research data, we would generally recommend to use laparoscopy and LA in patients with suspected appendicitis unless laparoscopy itself is contraindicated or not feasible. Especially young female, obese, and employed patients seem to benefit from LA.
Laparoscopic surgery for acute appendicitis has been proposed to have advantages over conventional surgery.
To compare the diagnostic and therapeutic effects of laparoscopic and conventional 'open' surgery.
We searched the Cochrane Library, MEDLINE, EMBASE, LILACS, CNKI, SciSearch, study registries, and the congress proceedings of endoscopic surgical societies.
We included randomized clinical trials comparing laparoscopic (LA) versus open appendectomy (OA) in adults or children. Studies comparing immediate OA versus diagnostic laparoscopy (followed by LA or OA if necessary) were separately identified.
Two reviewers independently assessed trial quality. Missing information or data was requested from the authors. We used odds ratios (OR), relative risks (RR), and 95% confidence intervals (CI) for analysis.
We included 67 studies, of which 56 compared LA (with or without diagnostic laparoscopy) vs. OA in adults. Wound infections were less likely after LA than after OA (OR 0.43; CI 0.34 to 0.54), but the incidence of intraabdominal abscesses was increased (OR 1.87; CI 1.19 to 2.93). The duration of surgery was 10 minutes (CI 6 to 15) longer for LA. Pain on day 1 after surgery was reduced after LA by 8 mm (CI 5 to 11 mm) on a 100 mm visual analogue scale. Hospital stay was shortened by 1.1 day (CI 0.7 to 1.5). Return to normal activity, work, and sport occurred earlier after LA than after OA. While the operation costs of LA were significantly higher, the costs outside hospital were reduced. Seven studies on children were included, but the results do not seem to be much different when compared to adults. Diagnostic laparoscopy reduced the risk of a negative appendectomy, but this effect was stronger in fertile women (RR 0.20; CI 0.11 to 0.34) as compared to unselected adults (RR 0.37; CI 0.13 to 1.01).