Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety

Surg Endosc. 2015 Jul;29(7):2027-32. doi: 10.1007/s00464-014-3906-y. Epub 2014 Oct 16.


Background: To date, no randomized control trial has been performed comparing open appendectomy (OA) to laparoscopic appendectomy (LA) in complicated appendicitis. A systematic review and meta-analysis in 2010 concluded LA is advantageous to OA with less surgical site sepsis in complicated appendicitis; however, the level of evidence is weak (level 3a). The aim of the study was to determine whether LA is safe in the treatment of complicated appendicitis. Primary outcome included all-cause mortality and procedure-related mortality; secondary outcomes included intra-operative duration, rates of wound sepsis and re-intervention, length of hospital stay and re-admission rates.

Methods: One hundred and fourteen patients were randomized prospectively to either OA or LA using a computer-generated blind method. Patients who were either less than 12 years of age, had previous abdominal surgery or were pregnant were excluded. A team of senior surgeons capable of doing both OA and LA performed all procedures.

Results: The intra-operative duration, the rate of wound sepsis, the number of re-operations, the length of hospital stay and the rate of re-admissions between the OA and LA groups did not differ statistically.

Conclusion: Laparoscopic appendectomy is safe in complicated appendicitis. Current Control Trials (ISRCTN92257749).

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Appendectomy / methods*
  • Appendicitis / surgery*
  • Female
  • Humans
  • Laparoscopy / methods
  • Laparotomy / methods
  • Length of Stay / statistics & numerical data
  • Male
  • Operative Time
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications / epidemiology*
  • Reoperation
  • Sepsis / epidemiology*
  • Surgical Wound Infection / epidemiology
  • Treatment Outcome
  • Young Adult

Associated data

  • ISRCTN/ISRCTN92257749