Laparoscopic versus Open Appendectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis

Abstract

Introduction: Complicated appendicitis, characterized by perforation or abscess, presents a significant surgical challenge. While laparoscopic appendectomy is standard for simple cases, its role in complicated appendicitis is still debated. This review compares the outcomes of laparoscopic versus open surgery for this condition.

Methods: A comprehensive search of MEDLINE, Embase, and the Cochrane Library was conducted for randomized controlled trials (RCTs) and cohort studies. We included studies comparing laparoscopic to open appendectomy in patients with complicated appendicitis. Primary outcomes were intra-abdominal abscess formation and surgical site infection (SSI).

Results: The meta-analysis included 25 studies. The laparoscopic approach was associated with a significantly lower rate of superficial SSIs compared to the open approach. However, the rate of postoperative intra-abdominal abscess formation was slightly higher in the laparoscopic group. Operative time was longer for laparoscopy, but hospital stay was shorter.

Discussion: The choice between laparoscopic and open surgery for complicated appendicitis involves a trade-off. Laparoscopy reduces wound infections and hospital stay but may increase the risk of intra-abdominal abscess, requiring careful surgical technique and irrigation.

Conclusion: Laparoscopic appendectomy is a viable and safe option for complicated appendicitis, offering benefits in wound infection rates and recovery.