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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

COMPLICATED APPENDICITIS

LAPAROSCOPIC VERSUS OPEN APPENDECTOMY

IN SEARCH OF EVIDENCE…

Clif Wierink

abbreviations
ABBREVIATIONS

CAComplicated Appendicitis

LALaparoscopicAppendectomy

OAOpen AppendectomyIAAIntra-AbdominalAbscess

SSISurgical Site Infection

slide3
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
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
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)

in short1
In short…
  • Multicenterretrospectiveobservationalstudy(‘06-’08)
  • 40.337appendectomies, of which10.535 CA
  • Primaryoutcomemeasuresfavouring LA
  • Secondaryoutcomemeasuresfavouring LA
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
references
References
  • WORLD J SURG (2010) 34:2026–2040 LAPAROSCOPIC 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.
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