MedWire News: Patients with acute appendicitis should be treated with laparoscopic appendectomy (LA) instead of open appendectomy (OA), suggest Chinese researchers who found greater reductions in hospital stay, postoperative pain, and complication rates, in addition to earlier recovery.
Jialin Zhang (China Medical University, Liaoning Province) and co-authors say that although laparoscopic surgery has been available for some time, it is still not clear whether OA or LA is the most appropriate surgical approach to acute appendicitis.
The researchers therefore performed a meta-analysis of 44 randomized controlled trials comparing LA and OA in adults and children, including a total of 5292 patients.
Pooled data showed that LA resulted in a mean reduction of 0.60 days in postoperative hospital stay compared with OA, with patients resuming their normal activities and original diet a respective average of 4.52 and 0.34 days earlier. However, the researchers say that the impact of less than a full day for return to normal eating remains doubtful.
Zhang and team also found that pain on the first postoperative day was significantly lower for those treated using LA, scoring an average 0.70 points less on the Visual Analogue Scale compared with OA. Furthermore, the risk of wound infection after LA was 55% less likely compared with OA (3.81% vs 8.41%, respectively), and only 9.5% of patients were switched from LA to OA.
Both procedures were associated with similar rates of postoperative ileus, and no significant differences were found for rates of intra-abdominal abscess, intraoperative bleeding and urinary tract infection. Despite the nonsignificance of these findings, the researchers say that the higher rate of these complications with LA should be noted and that further investigation into their cause is necessary.
Operating time was on average 12.4 minutes longer for LA than OA. Commenting on this finding, Zhang et al say: "A reputation for extended operating time a major disadvantage, and has considerably influenced the widespread use of LA... This may have been due to the inexperience of the surgeons with the new technique. However, with increased experience the mean operating time of LA and OA becomes similar."
Writing in the journal BMC Gastroenterology, the team concludes that "the widespread use of LA [should be] routinely recommended in hospitals where laparoscopic expertise and equipment are available."
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