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, z(1) = 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.
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, z(1) = 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.
Authors: B D Matthews; G Mostafa; K L Harold; K W Kercher; P R Reardon; B T Heniford Journal: Surg Laparosc Endosc Percutan Tech Date: 2001-12 Impact factor: 1.719
Authors: Daniel H W Lau; Kevin K K Yau; C C Chung; Fiona C S Leung; Y P Tai; Michael K W Li Journal: Surg Laparosc Endosc Percutan Tech Date: 2005-04 Impact factor: 1.719
Authors: E M Azaro; P C Amaral; J E Ettinger; E L Souza; M F Fortes; R S Alcântara; A B Regis; M M Sousa; W G Fogagnoli; V M do Carmo; T D Galvão; E P Stagliorio; P A Santana; E Fahel Journal: JSLS Date: 1999 Oct-Dec Impact factor: 2.172