No advantage of Laparoscopic surgery over open surgery in reducing the risk of bowel obstruction in complicated appendicitis suggests a new study published in the Journal of Pediatric Surgery. Complicated appendicitis is associated with a higher risk of postoperative complications, including adhesive bowel obstruction. This meta-analysis aims to investigate the difference in rates of postoperative bowel obstruction in paediatric patients with complicated versus simple appendicitis and whether the surgical approach influences this. A systematic literature search following PRISMA guidelines was conducted using MEDLINE, Embase and Cochrane Library for studies that analysed the incidence of adhesive bowel obstruction in paediatric patients after appendicectomy. Studies from 1998 – 2022 were included in the analysis. Results: A pooled analysis of 6 studies with low risk of bias and adequate follow-up periods, considering 58,962 cases of appendicectomy, revealed complex appendicitis was associated with a near two-fold increase in the incidence of SBO (pooled odds ratio 2.02 (95% CI 1.35 - 2.69)).
Interestingly, a similar pooled analysis of 10 studies, considering 62,433 cases of appendicectomy, revealed no significant difference between open and laparoscopic management of complex appendicitis (pooled odds ratio 0.93 (95% CI 0.24 to 1.62)). Complex appendicitis is associated with a two-fold increase in the rates of adhesive bowel obstruction. Whilst there are cosmetic advantages of a laparoscopic approach, surgical expertise should be favoured in decision-making relating to the surgical approach (laparoscopic versus open) as the evidence for a laparoscopic approach reducing risks of adhesive bowel obstruction is not convincing.
Reference:
Neel Doshi, Soham Bandyopadhyay, Madeline Green, Edward Richardson, Ahmad Komber, Si Emma Chen, Rahul Shah, Kokila Lakhoo. The risk of adhesive Bowel obstruction in children with appendicitis: A systematic review, Journal of Pediatric Surgery, 2024, ISSN 0022-3468. https://doi.org/10.1016/j.jpedsurg.2024.03.021.
(https://www.sciencedirect.com/science/article/pii/S0022346824001738)