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Open versus laparoscopic appendicectomy

A critical review

  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

The benefit of laparoscopic appendicectomy remains unclear. We have analysed available randomised studies comparing laparoscopic and open appendicectomy regarding their clinical pitfalls and statistical relevance.

Methods

Thirty eight studies were analysed in terms of the following aspects: A. clinical problems (e.g., expertise of the surgeons, pre- and postoperative antibiotic treatment, definition of complications, blinding of outcomes) and B. statistical problems (e.g., definition of primary and secondary outcomes, power and sample size, statistical methods, confidence intervals, comparability of groups and studies).

Results

Most of the studies have clinical and statistical pitfalls. The most important pitfalls are the uncertain expertise of the operating surgeons, blinding, and the exploratory nature of the studies. Our analysis aims at giving useful information for the appraisal of existing studies and the conduct of further studies. It also gives some preliminary results.

Conclusions

More than twenty years after Semm performed the first laparoscopic appendicectomy, it is necessary to clarify the superiority of laparoscopic or open appendectomy with well-defined, carefully designed randomised studies.

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Acknowledgments

M.K. and A.C. contributed equally to this paper. They both should be regarded as first authors.

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Authors and Affiliations

  1. Department of General and Thoracic Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold Heller Strasse 07, D-24105, Kiel, Germany

    M. Kapischke & J. Tepel

  2. Institute for Medical Informatics and Statistics, University Hospital of Schleswig-Holstein, Campus Kiel, Brunswiker Strasse 10, D-24105, Kiel, Germany

    A. Caliebe & J. Hedderich

  3. Department of Surgery, University Hospital of the Justus von Liebig University, Rudolf Buchheim Strasse, D-35385, Gießen, Germany

    T. Schulz

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  1. M. Kapischke
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  2. A. Caliebe
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Correspondence to M. Kapischke.

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Kapischke, M., Caliebe, A., Tepel, J. et al. Open versus laparoscopic appendicectomy. Surg Endosc 20, 1060–1068 (2006). https://doi.org/10.1007/s00464-005-0016-x

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