Comparison of the Laparoscopic Appendectomy and Open Appendectomy in Limited Resource Settings: A Systematic Review and Meta-Analysis

Abstract

Background

Surgery remains a cornerstone in the management of acute appendicitis. Two main approaches to appendectomy are considered: open and laparoscopic. This study aimed to conduct a systematic review and meta-analysis comparing both approaches in low- and middle-income countries (LMICs).

Methods

We conducted a thorough search across several databases, including PubMed and Google Scholar, using relevant keywords tailored to each. The research focused on adult patients from low- and middle-income countries, encompassing randomized controlled trials and non-randomized observational studies. This study is registered with PROSPERO (ID: CRD42024600883).

Results

The analysis included 12 studies in meta-analysis, 1,897 participants, 6 randomized controlled trials (RCTs), and 6 observational studies. 1,024(53.9%) underwent an open appendectomy, 873(46.1%) laparoscopic appendectomy and 754(40.9%) of the patients were males and 1,091(59.1%) were females. Laparoscopic appendectomy was associated with a reduced operating time compared to open appendectomy (Cohen’s d: -0.2, 95% CI: -2.06 to 1.64, p=0.92). The incidence of surgical site infection (SSI) was lower in the laparoscopic group (odds ratio [OR]: 0.50, 95% CI: 0.19-1.92, p=0.16), and patients experienced shorter hospital stays following laparoscopic surgery (Cohen’s d: -0.79, 95% CI: -1.92 to 0.34, p=0.17). Recovery times were significantly quicker in the laparoscopic group (Cohen’s d: -2.09, 95% CI: -3.33 to -0.05, p = 0.00). Postoperative pain scores were comparable between the two techniques (Cohen’s d: -0.52, 95% CI: -0.85 to -0.19, p<0.01). Laparoscopic appendectomy was costlier (mean/SD $142±1.7 USD) than open appendectomy ($110.8±3.1 USD) from one RCT. In observational studies, the cost of laparoscopic appendectomy was significantly higher (Cohen’s d: 1.60, 95% CI: 0.21-2.98, p = 0.02).

Conclusions

Laparoscopic appendectomy showed significant clinical outcomes; however, it was a higher cost than open appendectomy in lower- and middle-income countries.