COMPLICATED APPENDICITIS

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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. - PowerPoint PPT Presentation

Text of COMPLICATED APPENDICITIS

Appendicitis perforata

COMPLICATED APPENDICITISLAPAROSCOPIC VERSUS OPEN APPENDECTOMY

IN SEARCH OF EVIDENCE

Clif WierinkABBREVIATIONSCAComplicated AppendicitisLALaparoscopic AppendectomyOAOpen AppendectomyIAAIntra-Abdominal AbscessSSISurgical Site InfectionPICOPADULT WITH APPENDICITIS, COMPLICATEDILAPAROSCOPIC APPENDECTOMYCOPEN (CONVENTIONAL) APPENDECTOMYOINTRA-ABDOMINAL ABSCESS (IAA) FORMATIONSECONDARY: SURGICAL SITE INFECTION, POST-OP PAIN, RE-ADMISSION, LENGTH OF STAY, HOSPITAL COSTSLevels of evidence

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])Met gestelde limits 37 resultaten5THE SEARCH LIMITSPublished in last 5 yearsEnglishHumansMeta-analysis, Systematic review, RCT, Clinical trialSR & Meta-Analysis

In short12 retrospective case-control studies includedObservation of 1127 patients with regard to IAANo significant difference between LA and OA for IAAsSecondary outcomes largely favour LAPRIMARY OUTCOME

Intra-abdominal abscess rate meta-analysis (all studies included)SECONDARY OUTCOMES

ANOTher article

In shortMulticenter retrospective observational study (06-08)40.337 appendectomies, of which 10.535 CAPrimary outcome measures favouring LASecondary outcome measures favouring LA

Outcomes

DISCUSSIONRETROSPECTIVE STUDIES, POSSIBLY HIGH LEVELS OF BIASHETEROGENEITY BETWEEN STUDIES SURGEONS EXPERIENCEDIFFERENT METHODS OF LIGATIONDIFFERENT PERIOPERATIVE ANTIBIOTIC REGIMENSSHORT FOLLOW-UP PERIODS (< 1 MONTH)Cochrane review: Laparoscopic versus open surgery for suspected appendicitis14RecommendationLAPAROSCOPIC INTERVENTION IS SUPERIOR TO THE OPEN PROCEDURE IN TERMS OF SECONDARY OUTCOME MEASURESNO SIGNIFICANT DIFFERENCES IN IAA FORMATION

EVIDENCE LEVEL 3ACochrane review: Laparoscopic versus open surgery for suspected appendicitisLevel 3A: Systematic reviews based on retrospective case control studies15VRAGEN

ReferencesWORLD J SURG (2010) 34:20262040LAPAROSCOPIC VERSUS OPEN APPENDECTOMY IN ADULTS WITH COMPLICATED APPENDICITIS: SYSTEMATIC REVIEW AND META-ANALYSIS; MARKIDES, SUBAR, RIYADANNALS OF SURGERY VOLUME 254, NUMBER 6, DECEMBER 2011COMPARISON OF OUTCOMES OF LAPAROSCOPIC AND OPEN APPENDECTOMY IN MANAGEMENT OF UNCOMPLICATED AND COMPLICATED APPENDICITIS; TIWARI ET AL.