Complicated appendicitis
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COMPLICATED APPENDICITIS. LAPAROSCOPIC VERSUS OPEN APPENDECTOMY IN SEARCH OF EVIDENCE… Clif Wierink. ABBREVIATIONS. CA Complicated Appendicitis LA Laparoscopic Appendectomy OA Open Appendectomy IAA Intra- Abdominal Abscess SSI Surgical Site Infection. PICO.

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COMPLICATED APPENDICITIS

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Complicated appendicitis

COMPLICATED APPENDICITIS

LAPAROSCOPIC VERSUS OPEN APPENDECTOMY

IN SEARCH OF EVIDENCE…

Clif Wierink


Abbreviations

ABBREVIATIONS

CAComplicated Appendicitis

LALaparoscopicAppendectomy

OAOpen AppendectomyIAAIntra-AbdominalAbscess

SSISurgical Site Infection


Complicated appendicitis

PICO

  • PADULT WITH APPENDICITIS, COMPLICATED

  • ILAPAROSCOPIC APPENDECTOMY

  • COPEN (CONVENTIONAL) APPENDECTOMY

  • OINTRA-ABDOMINAL ABSCESS (IAA) FORMATION

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


The search pubmed

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

THE SEARCH LIMITS…

  • Published in last 5 years

  • English

  • Humans

  • Meta-analysis, Systematic review, RCT, Clinical trial


Sr meta analysis

SR & Meta-Analysis


In short

In short…

  • 12retrospective case-control studies included

  • Observation of 1127patientswithregardtoIAA

  • No significant differencebetween LA and OA forIAAs

  • SecondaryoutcomeslargelyfavourLA


Primary outcome

PRIMARY OUTCOME

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


Secondary outcomes

SECONDARY OUTCOMES


Another article

ANOTherarticle…


In short1

In short…

  • Multicenterretrospectiveobservationalstudy(‘06-’08)

  • 40.337appendectomies, of which10.535 CA

  • Primaryoutcomemeasuresfavouring LA

  • Secondaryoutcomemeasuresfavouring LA


Outcomes

Outcomes


Discussion

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

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

VRAGEN


References

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 2011COMPARISON OF OUTCOMES OF LAPAROSCOPIC AND OPEN APPENDECTOMY IN MANAGEMENT OF UNCOMPLICATED AND COMPLICATED APPENDICITIS; TIWARI ET AL.


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