Laparoscopic vs. open appendicectomy
Sübutlu məlumatların xülasələri
03.08.2017 • Sonuncu dəyişiklik 03.08.2017
Editors
Provided that surgical expertise and equipment are adequate, diagnostic laparoscopy and laparoscopic appendectomy (either in combination or separately) result in various advantages over open appendectomy.
A Cochrane review included 67 studies of which 56 compared laparoscopic (LA; with or without diagnostic laparoscopy) versus open appendectomy (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 min longer for LA (95% CI 6 to 15). Pain on day 1 after surgery was reduced after LA by 8 mm (95% CI 5 to 11) on a 100 mm visual analogue scale (VAS). Hospital stay was reduced by 1.1 days (95% CI 0.7 to 1.5) for LA. 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 result 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).
A systematic review
including 10 studies with a total of 633 patients receiving laparoscopic and 542 receiving open surgery was abstracted in DARE. The operating time was longer for laparoscopic surgery in all studies (the difference ranging from 8 to 29 minutes). Postoperative stay was shorter in laparoscopic cholecystectomy in 5 of the 6 trials which assessed this outcome. In the majority of trials laparoscopic cholecystectomy was associated with a quicker return to normal activity (mean difference ranged from 0.6 to 17 days).
The difference was significant in 4 of the 7 trials which assessed this outcome. The odds ratio for wound infections was higher in patients receiving open cholecystectomy (OR 2.6, 95% CI 1.3 to 5.2).
Comment: Bias, particularly resulting from a lack of blinding, was observed.
Another systematic review
abstracted in DARE included 16 RCTs with a total of 1,682 patients. The duration of surgery was 69.8 minutes (LA) vs 52.9 minutes (OA), p<0.0001. Length of hospital stay was 3.23 days (LA) versus 3.84 days (OA), p=0.03. Postoperative pain was less for LA than for OA, effect size -0.38, 95% CI -0.13 to -0.64, p=0.003. Incidence of wound infection was 2.8% (LA) vs 7% (OA), effect size 0.30, 95% CI 0.19 to 0.47, p<0.0001. Intra-abdominal abscess was 2.02% (LA) vs 0.937 (OA), p=0.09. Time to resumption of normal activities was 11.9 days (LA) vs 19.0 days (OA).
A third systematic review
abstracted in DARE included 11 RCTs with 1.373 patients. The differences favouring laparoscopic surgery were as follows: Time to full functioning -5.48 days (95% CI -7.26 to -3.70), pain -1.19 points (95% CI -2.14 to -0.24), wound infection rate -3.2% (-5.6 to -0.8%). There were non-significantly more cases of ileus (1.2%) and abscess (0.8%) in the laparoscopic surgery group. The additional cost of laparoscopic procedure in studies reported from 1993 to 1997 was 1,724 dollars.
Ədəbiyyat
- Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2010;(10):CD001546. .
McCall JL, Sharples K, Jadallah F. Systematic review of randomized controlled trials comparing laparoscopic with open appendicectomy. Br J Surg 1997 Aug;84(8):1045-50.
Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: a metaanalysis. J Am Coll Surg 1998 May;186(5):545-53.
Garbutt JM, Soper NJ, Shannon WD, Botero A, Littenberg B. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc 1999 Jan;9(1):17-26.