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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2015

01-07-2015

Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety

Authors: John-Edwin Thomson, Deirdré Kruger, Christine Jann-Kruger, Akos Kiss, J. A. O. Omoshoro-Jones, Thifheli Luvhengo, Martin Brand

Published in: Surgical Endoscopy | Issue 7/2015

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Abstract

Background

To date, no randomized control trial has been performed comparing open appendectomy (OA) to laparoscopic appendectomy (LA) in complicated appendicitis. A systematic review and meta-analysis in 2010 concluded LA is advantageous to OA with less surgical site sepsis in complicated appendicitis; however, the level of evidence is weak (level 3a). The aim of the study was to determine whether LA is safe in the treatment of complicated appendicitis. Primary outcome included all-cause mortality and procedure-related mortality; secondary outcomes included intra-operative duration, rates of wound sepsis and re-intervention, length of hospital stay and re-admission rates.

Methods

One hundred and fourteen patients were randomized prospectively to either OA or LA using a computer-generated blind method. Patients who were either less than 12 years of age, had previous abdominal surgery or were pregnant were excluded. A team of senior surgeons capable of doing both OA and LA performed all procedures.

Results

The intra-operative duration, the rate of wound sepsis, the number of re-operations, the length of hospital stay and the rate of re-admissions between the OA and LA groups did not differ statistically.

Conclusion

Laparoscopic appendectomy is safe in complicated appendicitis. Current Control Trials (ISRCTN92257749)
Literature
1.
Addiss DG, Shaffer N, Fowler BS et al (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925PubMed
2.
McBurney C (1894) The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg 20:38–43PubMedCentralPubMedCrossRef
3.
4.
Pier A, Gotz F, Bacher C (1991) Laparoscopic appendectomy in 625 cases: from innovation to routine. Surg Laparosc Endosc 1:8–13PubMed
5.
6.
Schirmer BD, Schmieg RE, Dix J et al (1993) Laparoscopic versus traditional appendectomy for suspected appendicitis. Am J Surg 165:670–675PubMedCrossRef
7.
Bonanni F, Reed J, Hartzell G et al (1994) Laparoscopic versus conventional appendectomy. J Am Coll Surg 179:273–278PubMed
8.
Ortega AE, Hunter JG, Peters JH et al (1995) A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic Appendectomy Study Group. Am J Surg 169:208–212PubMedCrossRef
9.
Hansen JB, Smithers BM, Schache D et al (1996) Laparoscopic versus open appendectomy: prospective randomized trial. World J Surg 20:17–20PubMedCrossRef
10.
Reiertsen O, Larsen S, Trondsen E et al (1997) Randomized controlled trial with sequential design of laparoscopic versus conventional appendicectomy. Br J Surg 84:842–847PubMedCrossRef
11.
Kum CK, Ngoi SS, Goh PM et al (1993) Randomized controlled trial comparing laparoscopic and open appendicectomy. Br J Surg 80:1599–1600PubMedCrossRef
12.
McCall JL, Sharples K, Jadallah F (1997) Systematic review of randomized controlled trials comparing laparoscopic with open appendicectomy. Br J Surg 84:1045–1050PubMedCrossRef
13.
Kazemier G, de Zeeuw GR, Lange JF et al (1997) Laparoscopic vs open appendectomy. A randomized clinical trial. Surg Endosc 11:336–340PubMedCrossRef
14.
Golub R, Siddiqui F, Pohl D (1998) Laparoscopic versus open appendectomy: a metaanalysis. J Am Coll Surg 186:545–553PubMedCrossRef
15.
Chung RS, Rowland DY, Li P et al (1999) A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg 177:250–256PubMedCrossRef
16.
Hellberg A, Rudberg C, Kullman E et al (1999) Prospective randomized multicentre study of laparoscopic versus open appendicectomy. Br J Surg 86:48–53PubMedCrossRef
17.
Pedersen AG, Petersen OB, Wara P et al (2001) Randomized clinical trial of laparoscopic versus open appendicectomy. Br J Surg 88:200–205PubMedCrossRef
18.
Katkhouda N, Mason RJ, Towfigh S (2006) Laparoscopic versus open appendectomy: a prospective, randomized, double-blind study. Adv Surg 40:1–19PubMedCrossRef
19.
Li X, Zhang J, Sang L et al (2010) Laparoscopic versus conventional appendectomy—a meta-analysis of randomized controlled trials. BMC Gastroenterol 10:129–230PubMedCentralPubMedCrossRef
20.
Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 6:CD001546
21.
Tzovaras G, Baloyiannis I, Kouritas V et al (2010) Laparoscopic versus open appendectomy in men: a prospective randomized trial. Surg Endosc 24:2987–2992PubMedCrossRef
22.
23.
24.
Cox MR, McCall JL, Toouli J et al (1996) Prospective randomized comparison of open versus laparoscopic appendectomy in men. World J Surg 20:263–266PubMedCrossRef
25.
Wei HB, Huang JL, Zheng ZH et al (2010) Laparoscopic versus open appendectomy: a prospective randomized comparison. Surg Endosc 24:266–269PubMedCrossRef
26.
Heikkinen TJ, Haukipuro K, Hulkko A (1998) Cost-effective appendectomy. Open or laparoscopic? A prospective randomized study. Surg Endosc 12:1204–1208PubMedCrossRef
27.
Piskun G, Kozik D, Rajpal S et al (2001) Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis. Surg Endosc 15:660–662PubMedCrossRef
28.
Katsuno G, Nagakari K, Yoshikawa S et al (2009) Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy. World J Surg 33:208–214PubMedCrossRef
29.
Garg CP, Vaidya BB, Chengalath MM (2009) Efficacy of laparoscopy in complicated appendicitis. Int J Surg 7:250–252PubMedCrossRef
30.
Khiria LS, Ardhnari R, Mohan N et al (2011) Laparoscopic appendicectomy for complicated appendicitis: is it safe and justified? A retrospective analysis. Surg Laparosc Endosc Percutan Tech 21:142–145PubMedCrossRef
31.
32.
Dimitriou I, Reckmann B, Nephuth O et al (2013) Single institution’s experience in laparoscopic appendectomy as a suitable therapy for complicated appendicitis. Langenbecks Arch Surg 398:147–152PubMedCrossRef
33.
Katkhouda N, Mason RJ, Towfigh S (2006) Laparoscopic versus open appendectomy: a prospective, randomized, double-blind study. Adv Surg 40:1–19PubMedCrossRef
34.
Williams MD, Collins JN, Wright TF et al (1996) Laparoscopic versus open appendectomy. South Med J 89:668–674PubMedCrossRef
35.
Vinay K, Nelson F, Abul A et al (2010) Acute appendicitis. In: William S (ed) Pathologic basis of disease. Saunders, Philadelphia, p 827
36.
Rogers AD, Hampton MI, Bunting M et al (2008) Audit of appendicectomies at Frere Hospital, Eastern Cape. S Afr J Surg 46:74–77PubMed
37.
Tate JJ, Dawson JW, Chung SC et al (1993) Laparoscopic versus open appendicectomy: prospective randomised trial. Lancet 342:633–637PubMedCrossRef
38.
Minne L, Varner D, Burnell A et al (1997) Laparoscopic vs open appendectomy. Prospective randomized study of outcomes. Arch Surg 132:708–711PubMedCrossRef
39.
Markides G, Subar D, Riyad K (2010) Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg 34:2026–2040PubMedCrossRef
40.
Kong VY, Van der Linde S, Aldous C et al (2013) Quantifying the disparity in outcome between urban and rural patients with acute appendicitis in South Africa. S Afr Med J 103:742–745PubMedCrossRef
41.
Di Saverio S, Mandrioli M, Sibilio A et al (2014) A cost-effective technique for laparoscopic appendectomy: outcomes and costs of a case-control prospective single-operator study of 112 unselected consecutive cases of complicated acute appendicitis. J Am Coll Surg 218:51–65CrossRef
Metadata
Title
Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety
Authors
John-Edwin Thomson
Deirdré Kruger
Christine Jann-Kruger
Akos Kiss
J. A. O. Omoshoro-Jones
Thifheli Luvhengo
Martin Brand
Publication date
01-07-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3906-y

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