Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 12/2019

01-12-2019 | Ileus

Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis

Authors: Zhi Xuan Low, Glenn Kunnath Bonney, Jimmy Bok Yan So, Dale Lincoln Loh, Jun Jie Ng

Published in: Surgical Endoscopy | Issue 12/2019

Login to get access

Abstract

Background

Acute appendicitis is a common condition in the pediatric population. In patients with uncomplicated appendicitis, laparoscopic appendectomy (LA) is preferred as compared to open appendectomy (OA). However, in patients with complicated appendicitis (CA), as defined as suppurative, gangrenous or perforated appendicitis, or appendicitis with periappendicular abscess formation, the decision to perform OA or LA remains unclear.

Methods

The PRISMA guidelines were adhered to. An electronic database search from 1997 to 2017 was performed using the Cochrane, Medline, PubMed, Scopus, Ovid, Embase, and Web of Knowledge databases. Data analysis, including subgroup analysis of randomized-control trials, was performed using RevMan 5.3. Assessment of methodological and statistical heterogeneity, as well as publication bias of the included studies, was performed.

Results

Six randomized-control trials (296 LA versus 373 OA) and 33 case–control trials (3106 LA versus 4149 OA) were analyzed. Compared to OA, LA has a shorter length of stay (WMD = − 0.96, 95% CI − 1.47 to − 0.45) and a lower rate of surgical site infection (OR 0.37, 95% CI 0.25–0.54), although the rates of intraabdominal abscess formation were similar (OR 1.01, 95% CI 0.71–1.43). LA was also shown to have lower readmission rates, lower incidences of postoperative ileus or intestinal obstruction, lower incidence of reoperation, as well as a shorter time taken to oral intake. Operative time for OA was shorter than LA (WMD = 12.44, 95% CI 2.00–22.87).

Conclusion

While studies in the past have associated LA with higher rates of intraabdominal abscess in patients with CA, our meta-analysis has shown that they were similar. Considering this, together with other improved postoperative outcomes, LA should be the procedure of choice in pediatric patients presenting with CA.
Appendix
Available only for authorised users
Literature
1.
Aarabi S, Sidhwa F, Riehle KJ, Chen Q, Mooney DP (2011) Pediatric appendicitis in New England: epidemiology and outcomes. J Pediatr Surg 46:1106–1114PubMed
2.
Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V (2012) Changing epidemiology of acute appendicitis in the United States: study period 1993–2008. J Surg Res 175:185–190PubMed
3.
Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925PubMed
4.
Brender JD, Marcuse EK, Koepsell TD, Hatch EI (1985) Childhood appendicitis: factors associated with perforation. Pediatrics 76:301–306PubMed
5.
6.
McBURNEY C (1894) IV. The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg 20:38PubMedPubMedCentral
7.
Cheong LHA, Emil S (2014) Pediatric laparoscopic appendectomy: a population-based study of trends, associations, and outcomes. J Pediatr Surg 49:1714–1718PubMed
8.
Vahdad MR, Troebs R-B, Nissen M, Burkhardt LB, Hardwig S, Cernaianu G (2013) Laparoscopic appendectomy for perforated appendicitis in children has complication rates comparable with those of open appendectomy. J Pediatr Surg 48:555–561PubMed
9.
Esposito C, Calvo AI, Castagnetti M, Alicchio F, Suarez C, Giurin I, Settimi A (2012) Open versus laparoscopic appendectomy in the pediatric population: a literature review and analysis of complications. J Laparoendosc Adv Surg Tech A 22:834–839PubMed
10.
Aziz O, Athanasiou T, Tekkis PP, Purkayastha S, Haddow J, Malinovski V, Paraskeva P, Darzi A (2006) Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg 243:17–27PubMedPubMedCentral
11.
Markar SR, Blackburn S, Cobb R, Karthikesalingam A, Evans J, Kinross J, Faiz O (2012) Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg 16:1993–2004PubMed
12.
Dai L, Shuai J (2017) Laparoscopic versus open appendectomy in adults and children: a meta-analysis of randomized controlled trials. United Eur Gastroenterol J 5:542–553
13.
Bennett J, Boddy A, Rhodes M (2007) Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutaneous Tech 17:245–255
14.
Liu Z, Zhang P, Ma Y, Chen H, Zhou Y, Zhang M, Chu Z, Qin H (2010) Laparoscopy or not: a meta-analysis of the surgical effects of laparoscopic versus open appendicectomy. Surg Laparosc Endosc Percutaneous Tech 20:362–370
15.
Malagon AM, Arteaga-Gonzalez I, Rodriguez-Ballester L (2009) Outcomes after laparoscopic treatment of complicated versus uncomplicated acute appendicitis: a prospective, comparative trial. J Laparoendosc Adv Surg Tech A 19:721–725PubMed
16.
Tsai C-C, Lee S-Y, Huang F-C (2012) Laparoscopic versus open appendectomy in the management of all stages of acute appendicitis in children: a retrospective study. Pediatr Neonatol 53:289–294PubMed
17.
Law D, Law R, Eiseman B (1976) The continuing challenge of acute and perforated appendicitis. Am J Surg 131:533–535PubMed
18.
Bonanni F, Reed J, Hartzell G, Trostle D, Boorse R, Gittleman M, Cole A (1994) Laparoscopic versus conventional appendectomy. J Am Coll Surg 179:273–278PubMed
19.
Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X, Liu Y (2010) Laparoscopic versus conventional appendectomy–a meta-analysis of randomized controlled trials. BMC Gastroenterol 10:129PubMedPubMedCentral
20.
21.
Zhang S, Du T, Jiang X, Song C (2017) Laparoscopic appendectomy in children with perforated appendicitis: a meta-analysis. Surg Laparosc Endosc Percutaneous Tech 27:262–266
22.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140PubMed
23.
Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1. 0. The Cochrane Collaboration and John Wiley & Sons Ltd., England, pp 1–674
24.
Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13PubMedPubMedCentral
25.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716PubMed
26.
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928PubMedPubMedCentral
27.
Khirallah MG, Eldesouki NI, Elzanaty AA, Ismail KA, Arafa MA (2017) Laparoscopic versus open appendectomy in children with complicated appendicitis. Ann Pediatr Surg 13:17–20
28.
Lintula H, Kokki H, Vanamo K, Antila P, Eskelinen M (2002) Laparoscopy in children with complicated appendicitis. J Pediatr Surg 37:1317–1320PubMed
29.
Oka T, Kurkchubasche A, Bussey J, Wesselhoeft C, Tracy T, Luks F (2004) Open and laparoscopic appendectomy are equally safe and acceptable in children. Surg Endosc Other Interv Tech 18:242–245
30.
Karakuş OZ, Ulusoy O, Ateş O, Hakgüder G, Olguner M, Akgür FM (2016) Conventional single-port laparoscopic appendectomy for complicated appendicitis in children: Efficient and cost-effective. J Minimal Access Surg 12:16PubMedPubMedCentral
31.
Krisher SL, Browne A, Dibbins A, Tkacz N, Curci M (2001) Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136:438–441PubMed
32.
Lee SL, Yaghoubian A, Kaji A (2011) Laparoscopic vs open appendectomy in children: outcomes comparison based on age, sex, and perforation status. Arch Surg 146:1118–1121PubMed
33.
Li P, Han Y, Yang Y, Guo H, Hao F, Tang Y, Guo C (2017) Retrospective review of laparoscopic versus open surgery in the treatment of appendiceal abscess in pediatric patients: Laparoscopic versus open surgery for appendiceal abscess. Med 96:30
34.
Li P, Xu Q, Ji Z, Gao Y, Zhang X, Duan Y, Guo Z, Zheng B, Guo X, Wu X (2005) Comparison of surgical stress between laparoscopic and open appendectomy in children. J Pediatr Surg 40:1279–1283PubMed
35.
McKinlay R, Neeleman S, Klein R, Stevens K, Greenfeld J, Ghory M, Cosentino C (2003) Intraabdominal abscess following open and laparoscopic appendectomy in the pediatric population. Surg Endosc Other Interv Tech 17:730–733
36.
Menezes M, Das L, Alagtal M, Haroun J, Puri P (2008) Laparoscopic appendectomy is recommended for the treatment of complicated appendicitis in children. Pediatr Surg Int 24:303–305PubMed
37.
Miyano G, Okazaki T, Kato Y, Marusasa T, Takahashi T, Lane GJ, Yamataka A (2010) Open versus laparoscopic treatment for pan-peritonitis secondary to perforated appendicitis in children: a prospective analysis. J Laparoendosc Adv Surg Tech 20:655–657
38.
Nadler EP, Reblock KK, Qureshi FG, Hackam DJ, Gaines BA, Kane TD (2006) Laparoscopic appendectomy in children with perforated appendicitis. J Laparoendosc Adv Surg Tech 16:159–163
39.
Nwokoma NJ, Swindells MG, Pahl K, Mathur AB, Minocha A, Kulkarni M, Tsang T (2009) Pediatric advanced appendicitis: open versus laparoscopic approach. Surg Laparosc Endosc Percutaneous Tech 19:110–113
40.
Rai R, Chui C, Low Y, Yap T, Jacobsen A (2007) Perforated appendicitis in children: benefits of early laparoscopic surgery. Ann Acad Med Singap 36:277PubMed
41.
Taqi E, Al Hadher S, Ryckman J, Su W, Aspirot A, Puligandla P, Flageole H, Laberge J-M (2008) Outcome of laparoscopic appendectomy for perforated appendicitis in children. J Pediatr Surg 43:893–895PubMed
42.
Thambidorai C, Aman FY (2008) Laparoscopic appendicectomy for complicated appendicitis in children. Singap Med J 49:994–997
43.
Tirabassi MV, Tashjian DB, Moriarty KP, Konefal SH, Courtney RA, Sachs BF (2004) Perforated appendicitis: is laparoscopy safe? J Soc Laparoendosc Surg 8:147
44.
Wang X, Zhang W, Yang X, Shao J, Zhou X, Yuan J (2009) Complicated appendicitis in children: is laparoscopic appendectomy appropriate? A comparative study with the open appendectomy—our experience. J Pediatr Surg 44:1924–1927PubMed
45.
Yagmurlu A, Vernon A, Barnhart D, Georgeson K, Harmon C (2006) Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy. Surg Endosc Other Interv Tech 20:1051–1054
46.
Bıçakcı Ü, Tander B, Günaydın M, Rızalar R, Aritürk E, Ayyıldız SH, Bernay F (2011) The comparison of open and laparoscopic appendectomy: is there any outcome difference between non-complicated and complicated appendicitis? Balkan Med J 28:304–306
47.
Canty TG, Collins D, Losasso B, Lynch F, Brown C (2000) Laparoscopic appendectomy for simple and perforated appendicitis in children: the procedure of choice? J Pediatr Surg 35:1582–1585PubMed
48.
Chang HK, Han SJ, Choi SH, Oh J-T (2013) Feasibility of a laparoscopic approach for generalized peritonitis from perforated appendicitis in children. Yonsei Med J 54:1478–1483PubMedPubMedCentral
49.
Esposito C, Borzi P, Valla JS, Mekki M, Nouri A, Becmeur F, Allal H, Settimi A, Shier F, Sabin MG (2007) Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases. World J Surgery 31:750–755
50.
Groves LB, Ladd MR, Gallaher JR, Swanson J, Becher RD, Pranikoff T, Neff LP (2013) Comparing the cost and outcomes of laparoscopic versus open appendectomy for perforated appendicitis in children. Am Surg 79:861–864PubMed
51.
Horwitz JR, Custer MD, May BH, Mehall JR, Lally KP (1997) Should laparoscopic appendectomy be avoided for complicated appendicitis in children? J Pediatr Surg 32:1601–1603PubMed
52.
Ikeda H, Ishimaru Y, Takayasu H, Okamura K, Kisaki Y, Fujino J (2004) Laparoscopic versus open appendectomy in children with uncomplicated and complicated appendicitis. J Pediatr Surg 39:1680–1685PubMed
53.
Padankatti L, Pramod RK, Gupta A, Ramachandran P (2008) Laparoscopic versus open appendicectomy for complicated appendicitis: a prospective study. J Indian Assoc Pediatr Surg 13:104PubMedPubMedCentral
54.
Little DC, Custer MD, May BH, Blalock SE, Cooney DR (2002) Laparoscopic appendectomy: an unnecessary and expensive procedure in children? J Pediatr Surg 37:310–317PubMed
55.
Kaselas C, Molinaro F, Lacreuse I, Becmeur F (2009) Postoperative bowel obstruction after laparoscopic and open appendectomy in children: a 15-year experience. J Pediatr Surg 44:1581–1585PubMed
56.
Paya K, Rauhofer U, Rebhandl W, Horcher E (2000) Perforating appendicitis. Surg Endosc 14:182–184PubMed
57.
Tsao KJ, St Peter SD, Valusek PA, Keckler SJ, Sharp S, Holcomb GW, Snyder CL, Ostlie DJ (2007) Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg 42:939–942PubMed
58.
Valla J, Steyaert H, Alain L (1996) Management of appendicular peritonitis in children: traditional surgery vs. laparoscopy. Retrospective comparative study of pediatric video surgery group. Int J Pediatr Surg Sci 10:13–16
59.
Athanasiou C, Lockwood S, Markides GA (2017) Systematic review and meta-analysis of laparoscopic versus open appendicectomy in adults with complicated appendicitis: an update of the literature. World J Surg 41:3083–3099PubMed
60.
Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, Pietrobon R (2004) Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg 239:43PubMedPubMedCentral
61.
Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, Stamos MJ (2012) Comparison of outcomes of laparoscopic versus open appendectomy in children: data from the Nationwide Inpatient Sample (NIS), 2006–2008. World J Surgery 36:573–578
62.
Tashiro J, Einstein SA, Perez EA, Bronson SN, Lasko DS, Sola JE (2016) Hospital preference of laparoscopic versus open appendectomy: effects on outcomes in simple and complicated appendicitis. J Pediatr Surg 51:804–809PubMed
63.
Romy S, Eisenring M-C, Bettschart V, Petignat C, Francioli P, Troillet N (2008) Laparoscope use and surgical site infections in digestive surgery. Ann Surg 247:627–632PubMed
64.
Fleming FJ, Kim MJ, Messing S, Gunzler D, Salloum R, Monson JR (2010) Balancing the risk of postoperative surgical infections: a multivariate analysis of factors associated with laparoscopic appendectomy from the NSQIP database. Ann Surg 252:895–900PubMed
65.
Nataraja RM, Loukogeorgakis SP, Sherwood WJ, Clarke SA, Haddad MJ (2013) The incidence of intraabdominal abscess formation following laparoscopic appendicectomy in children: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 23:795–802PubMed
Metadata
Title
Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis
Authors
Zhi Xuan Low
Glenn Kunnath Bonney
Jimmy Bok Yan So
Dale Lincoln Loh
Jun Jie Ng
Publication date
01-12-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06709-x

Other articles of this Issue 12/2019

Surgical Endoscopy 12/2019 Go to the issue

OriginalPaper

Perioperative factors associated with pain following open ventral hernia repair

OriginalPaper

Safety first: significant risk of air embolism in laparoscopic gasketless insufflation systems

OriginalPaper

Feasibility and safety of duodenal covered self-expandable metallic stent fixation: an experimental study

OriginalPaper

Pure versus hand-assisted retroperitoneoscopic live donor nephrectomy: a retrospective cohort study of 1508 transplants from two centers

OriginalPaper

Billroth-I reconstruction using an overlap method in totally laparoscopic distal gastrectomy: propensity score matched cohort study of short- and long-term outcomes compared with Roux-en-Y reconstruction

OriginalPaper

Feasibility and safety of robotic resection of complicated diverticular disease