Ciarrocchi Andrea, Amicucci Gianfranco
Department of General and Emergency Surgery, University of L'Aquila, L'Aquila, Italy.
J Minim Access Surg. 2014 Jan;10(1):4-9. doi: 10.4103/0972-9941.124451.
A meta-analysis of different kinds of studies was performed to assess outcomes of laparoscopic versus open appendectomy in obese patients.
Retrospective and prospective studies enrolling patients with a body mass index greater than 30 kg/m(2) were included. Primary outcomes were days of hospital stay, surgical procedure duration, and overall post-operative complication rate. Secondary outcomes were wound infection and intra-abdominal abscesses formation rate, hospital charges.
Laparoscopic appendectomy showed to be significantly associated with lower wound infection (P < 0.001) and post-operative complication rate (P < 0.001). Surgical time was considered as a hallmark of technical challenge and resulted diminished in the laparoscopic group (P = 0.018). Although not clinically relevant per se, the statistically significant shorter hospital stay (P < 0.001) was probably the reason of decreased hospital charges (P < 0.001). Intra-abdominal abscesses formation rate was higher in the open appendectomy group (P = 0.058), although slightly above the statistical significance threshold.
Laparoscopic approach seemed to show relevant advantages compared to open appendectomy, but a large prospective trial is necessary to collect high quality data and investigate long-term outcomes.
进行了一项针对不同类型研究的荟萃分析，以评估肥胖患者行腹腔镜阑尾切除术与开腹阑尾切除术的结果。
纳入了体重指数大于30kg/m²患者的回顾性和前瞻性研究。主要结局指标为住院天数、手术持续时间和总体术后并发症发生率。次要结局指标为伤口感染和腹腔内脓肿形成率、住院费用。
腹腔镜阑尾切除术显示与较低的伤口感染率（P<0.001）和术后并发症发生率（P<0.001）显著相关。手术时间被视为技术挑战的标志，腹腔镜组的手术时间缩短（P = 0.018）。尽管本身与临床无关，但住院时间在统计学上显著缩短（P<0.001）可能是住院费用降低（P<0.001）的原因。开腹阑尾切除术组的腹腔内脓肿形成率较高（P = 0.058），尽管略高于统计学显著性阈值。
与开腹阑尾切除术相比，腹腔镜手术似乎具有显著优势，但需要进行一项大型前瞻性试验以收集高质量数据并研究长期结局。
