Transcript Appendicitis perforata

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
• 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) 34:2026–2040
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.