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COMPLICATED APPENDICITIS

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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  1. COMPLICATED APPENDICITIS LAPAROSCOPIC VERSUS OPEN APPENDECTOMY IN SEARCH OF EVIDENCE… Clif Wierink

  2. ABBREVIATIONS CAComplicated Appendicitis LALaparoscopicAppendectomy OAOpen AppendectomyIAAIntra-AbdominalAbscess SSISurgical Site Infection

  3. 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

  4. 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])

  5. THE SEARCH LIMITS… • Published in last 5 years • English • Humans • Meta-analysis, Systematic review, RCT, Clinical trial

  6. SR & Meta-Analysis

  7. In short… • 12retrospective case-control studies included • Observation of 1127patientswithregardtoIAA • No significant differencebetween LA and OA forIAAs • SecondaryoutcomeslargelyfavourLA

  8. PRIMARY OUTCOME Intra-abdominal abscess rate meta-analysis (all studies included)

  9. SECONDARY OUTCOMES

  10. ANOTherarticle…

  11. In short… • Multicenterretrospectiveobservationalstudy(‘06-’08) • 40.337appendectomies, of which10.535 CA • Primaryoutcomemeasuresfavouring LA • Secondaryoutcomemeasuresfavouring LA

  12. Outcomes

  13. 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)

  14. Recommendation • LAPAROSCOPIC INTERVENTION IS SUPERIOR TO THE OPEN PROCEDURE IN TERMS OF SECONDARY OUTCOME MEASURES • NO SIGNIFICANT DIFFERENCES IN IAA FORMATION • EVIDENCE LEVEL 3A

  15. VRAGEN

  16. 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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