Laparoscopic versus open appendicectomy for complicated appendicitis in children: A systematic review and meta-analysis

Background: Laparoscopic appendectomy (LA) is the preferred approach in uncomplicated appendicitis. However, in patients with complicated appendicitis (CA), the best approach is still unclear though la-paroscopy is being increasingly preferred over open appendicectomy (OA) nowadays. Aim: To comprehensively review the current literature and compare the associations of LA and OA con-cerning various postoperative outcomes in order to determine the best approach for children with CA. Methods: The PRISMA guidelines were adhered to and an electronic database search was extensively performed. Data analysis, including subgroup analysis of randomized-control trials, was performed us-ing RevMan 5.3. Methodological and statistical heterogeneity, as well as publication bias of the included studies, were assessed. Results: Four randomized controlled trials (266 LA versus 354 OA) and thirty-six case-controlled trials (2580 LA versus 3043 OA) were included in the analysis. Compared to OA, LA has a shorter length of stay, a lower rate of surgical site infection as well as a significantly lower overall complication rate. The rates of intraabdominal abscess formation, post-operative fever, pneumonia and ileus are similar in the two groups. So are the rates of readmissions and reoperations. LA was also shown to have a shorter time taken to oral intake and a lesser requirement of analgesics as well as intravenous antibiotics. Operative time for OA was found to be significantly shorter than that for LA. Conclusion: This meta-analysis objectively demonstrates that laparoscopy has a better overall complica-tion profile compared to OA and should be the procedure of choice in children with complicated appen-dicitis. (c) 2021 Elsevier Inc. All rights reserved.