Needlescopic versus laparoscopic appendectomy: a systematic review

Background Needlescopic appendectomies (NA) have been performed since the 1990s. We sought to systematically analyze trials comparing NA with laparoscopic appendectomies (LA) in the management of appendicitis. Methods We performed a systematic review of the literature. We compared and analyzed clini...

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Bibliographic Details
Published in:Canadian Journal of Surgery 2009-04, Vol.52 (2), p.129-134
Main Authors: Sajid, Muhammad Shafique, MBA, MSc, MD, Khan, Munir Ahmad, MRCS, Cheek, Elizabeth, PhD, Baig, Mirza Khurrum, MD
Format: Article
Language:fre ; eng
Subjects:
Appendectomy
Appendectomy - instrumentation
Appendectomy - methods
Appendicitis
Appendicitis - surgery
Care and treatment
Clinical trials
Clinical Trials as Topic
Comparative analysis
Diagnosis
Health aspects
Humans
Laparoscopic surgery
Laparoscopy
Length of Stay
Patients
Postoperative Complications
Studies
Surgery
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Summary:Background Needlescopic appendectomies (NA) have been performed since the 1990s. We sought to systematically analyze trials comparing NA with laparoscopic appendectomies (LA) in the management of appendicitis. Methods We performed a systematic review of the literature. We compared and analyzed clinical trials on NA and LA to generate summative data expressed as standardized mean differences (SMD). Results Of 5 retrieved trials from the electronic database 2 trials involving 412 patients met our inclusion criteria. In the fixed-effects models, NA took longer than LA, and this time difference was statistically significant: SMD 0.20 min, 95% confidence interval 0.01–0.40, p = 0.030, z1 = 2.09. In both fixed- and random-effects models, the difference in total hospital stay and in perioperative complications between the NA and LA groups were nonsignificant. Furthermore, in both fixed- and random-effects models, NA was associated with a higher conversion rate to open appendectomy than LA. There was no heterogeneity between the trials (Q = 0.34, p = 0.55). Conclusion Needlescopic appendectomy can be a safe and effective procedure for the management of appendicitis. It is comparable to LA in terms of hospital stay and perioperative complications. However, NA is associated with a longer duration of surgery and a higher conversion rate, indicating technical challenges of the procedure. Before recommending routine use of the needlescopic technique for appendectomy, a major multicentre randomized controlled trial is necessary.
ISSN:0008-428X
1488-2310