complicated appendicitis

COMPLICATED APPENDICITIS

LAPAROSCOPIC VERSUS OPEN APPENDECTOMY

IN SEARCH OF EVIDENCE…

Clif Wierink

ABBREVIATIONSCA COMPLICATED APPENDICITIS

LA LAPAROSCOPIC APPENDECTOMY

OA OPEN APPENDECTOMYIAA INTRA-ABDOMINAL ABSCESS

SSI SURGICAL SITE INFECTION

PICO• P ADULT WITH APPENDICITIS, COMPLICATED• I LAPAROSCOPIC APPENDECTOMY• C OPEN (CONVENTIONAL) APPENDECTOMY• O INTRA-ABDOMINAL ABSCESS (IAA) FORMATION

SECONDARY: SURGICAL SITE INFECTION, POST-OP PAIN, RE-ADMISSION, LENGTH OF STAY, HOSPITAL COSTS

THE SEARCH… (PUBMED)("APPENDICITIS"[MESH] OR "APPENDICITIS"[ALL FIELDS])

AND ("PERFORATED"[ALL FIELDS] OR "RUPTURED"[ALL FIELDS] OR

"COMPLICATED"[ALL FIELDS]) AND

("APPENDECTOMY"[ALL FIELDS] OR "APPENDICECTOMY"[ALL FIELDS]) AND

("LAPAROSCOPIC"[ALL FIELDS] OR "LAPAROSCOPY"[ALL FIELDS])

THE SEARCH LIMITS…• PUBLISHED IN LAST 5 YEARS• ENGLISH• HUMANS• META-ANALYSIS, SYSTEMATIC REVIEW, RCT, CLINICAL

TRIAL

SR & META-ANALYSIS

IN SHORT…• 12 RETROSPECTIVE CASE-CONTROL STUDIES

INCLUDED• OBSERVATION OF 1127 PATIENTS WITH REGARD TO

IAA• NO SIGNIFICANT DIFFERENCE BETWEEN LA AND OA

FOR IAAS• SECONDARY OUTCOMES LARGELY FAVOUR LA

PRIMARY OUTCOME

Intra-abdominal abscess rate meta-analysis (all studies included)

SECONDARY OUTCOMES

ANOTHER ARTICLE…

IN SHORT…• MULTICENTER RETROSPECTIVE OBSERVATIONAL

STUDY (‘06-’08)• 40.337 APPENDECTOMIES, OF WHICH 10.535 CA• PRIMARY OUTCOME MEASURES FAVOURING LA• SECONDARY OUTCOME MEASURES FAVOURING LA

OUTCOMES

DISCUSSION• RETROSPECTIVE STUDIES, POSSIBLY HIGH LEVELS

OF BIAS• HETEROGENEITY BETWEEN STUDIES • SURGEONS’ EXPERIENCE• DIFFERENT METHODS OF LIGATION• DIFFERENT PERIOPERATIVE ANTIBIOTIC REGIMENS• SHORT FOLLOW-UP PERIODS (< 1 MONTH)

RECOMMENDATION• LAPAROSCOPIC INTERVENTION IS SUPERIOR TO THE

OPEN PROCEDURE IN TERMS OF SECONDARY OUTCOME MEASURES

• NO SIGNIFICANT DIFFERENCES IN IAA FORMATION

• EVIDENCE LEVEL 3A

VRAGEN

REFERENCES

• WORLD J SURG (2010) 34:2026–2040LAPAROSCOPIC VERSUS OPEN APPENDECTOMY IN ADULTS WITH COMPLICATED APPENDICITIS: SYSTEMATIC REVIEW AND

META-ANALYSIS; MARKIDES, SUBAR, RIYAD• ANNALS OF SURGERY VOLUME 254, NUMBER 6, DECEMBER 2011

COMPARISON OF OUTCOMES OF LAPAROSCOPIC AND OPEN APPENDECTOMY IN MANAGEMENT OF UNCOMPLICATED AND COMPLICATED APPENDICITIS; TIWARI ET AL.