Laparoscopic versus open surgery for suspected appendicitis (Review)

Jaschinski T, Mosch CG, Eikermann M, Neugebauer EAM, Sauerland S

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517145/pdf/CD001546.pdf

Within the first week of my surgery rotation, I have already come across 3 laparoscopic appendectomies. Since it seems to be such a common issue I decided to find a journal article regarding its surgical management. I came across an interesting Systematic review and Meta-analysis article published in Cochrane Library comparing 2 different approaches as described in its title: “Laparoscopic versus open surgery for suspected appendicitis”. Its objective was to compare the benefits and harms of laparoscopic appendectomy (LA) versus open appendectomy (OA). The article searched through multiple journal databases, looking for randomized controlled trials that compare the two methods, in patients with signs and symptoms consistent with acute appendicitis. The primary outcomes looked at were the pain scale on the first day, wound infections within 14 days of the surgery, and intra-abdominal abscesses formed within 14 days of the surgery.  Secondary outcomes included the length of hospital stay, days until patient was able to return to normal activities, and quality of life within the 1 year of having the surgery. In total, 85 studies with a total of 9765 subjects were included in the study.

Pain intensity after surgery was less in LA (0.75/10 less than OA). In the studies that compared into the use of analgesic doses needed, 13/24 studies saw no difference between methods, but 11/24 studies show less analgesia needed in LA. LA showed half the amount of wound infections than OA, but higher incidence of intra-abdominal abscesses. In a majority of the articles, the length of hospital stay was less in LA versus OA by 0-5 days. Patients with LA returned to normal activity roughly 5 days faster than OA. Quality of life was better in LA vs OA, when measured on questionnaires that followed up  on the patients 2-6 weeks after the surgery.

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