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Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 1 Wound infections.
Figures and Tables -
Analysis 1.1

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 1 Wound infections.

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 2 Intraabdominal abscesses.
Figures and Tables -
Analysis 1.2

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 2 Intraabdominal abscesses.

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 3 Operation time (minutes).
Figures and Tables -
Analysis 1.3

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 3 Operation time (minutes).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 4 Anaesthesia time (minutes).
Figures and Tables -
Analysis 1.4

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 4 Anaesthesia time (minutes).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 5 Pain intensity on day 1 (cm VAS).
Figures and Tables -
Analysis 1.5

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 5 Pain intensity on day 1 (cm VAS).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 6 Length of hospital stay.
Figures and Tables -
Analysis 1.6

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 6 Length of hospital stay.

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 7 Time until reintroduction of liquid diet (days).
Figures and Tables -
Analysis 1.7

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 7 Time until reintroduction of liquid diet (days).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 8 Time until reintroduction of solid diet (days).
Figures and Tables -
Analysis 1.8

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 8 Time until reintroduction of solid diet (days).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 9 Time until first stool (days).
Figures and Tables -
Analysis 1.9

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 9 Time until first stool (days).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 10 Time until return to normal activity (days).
Figures and Tables -
Analysis 1.10

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 10 Time until return to normal activity (days).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 11 Time until return to work (days).
Figures and Tables -
Analysis 1.11

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 11 Time until return to work (days).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 12 Time until return to sport (days).
Figures and Tables -
Analysis 1.12

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 12 Time until return to sport (days).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 13 Cosmesis (cm VAS).
Figures and Tables -
Analysis 1.13

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 13 Cosmesis (cm VAS).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 14 Costs of the operation.
Figures and Tables -
Analysis 1.14

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 14 Costs of the operation.

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 15 Costs within hospital stay (incl. the operation).
Figures and Tables -
Analysis 1.15

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 15 Costs within hospital stay (incl. the operation).

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 16 Costs outside hospital.
Figures and Tables -
Analysis 1.16

Comparison 1 Laparoscopic versus conventional appendectomy in adults, Outcome 16 Costs outside hospital.

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 1 Wound infections (rate).
Figures and Tables -
Analysis 2.1

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 1 Wound infections (rate).

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 2 Intraabdominal abscesses (rate).
Figures and Tables -
Analysis 2.2

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 2 Intraabdominal abscesses (rate).

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 3 Operation time (minutes).
Figures and Tables -
Analysis 2.3

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 3 Operation time (minutes).

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 4 Anaesthesia time (minutes).
Figures and Tables -
Analysis 2.4

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 4 Anaesthesia time (minutes).

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 5 Pain intensity on day 1 (cm VAS).
Figures and Tables -
Analysis 2.5

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 5 Pain intensity on day 1 (cm VAS).

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 6 Length of hospital stay (days).
Figures and Tables -
Analysis 2.6

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 6 Length of hospital stay (days).

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 10 Time until mobilisation (days).
Figures and Tables -
Analysis 2.10

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 10 Time until mobilisation (days).

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 11 Time until return to normal activity (days).
Figures and Tables -
Analysis 2.11

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 11 Time until return to normal activity (days).

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 12 Time until return to sport (days).
Figures and Tables -
Analysis 2.12

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 12 Time until return to sport (days).

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 14 Costs of the operation.
Figures and Tables -
Analysis 2.14

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 14 Costs of the operation.

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 15 Costs within hospital stay (incl. the operation).
Figures and Tables -
Analysis 2.15

Comparison 2 Laparoscopic versus conventional appendectomy in children, Outcome 15 Costs within hospital stay (incl. the operation).

Comparison 3 Diagnostic laparoscopy (and open or laparoscopic appendectomy if necessary) versus immediate open appendectomy, Outcome 1 Negative appendectomy (rate).
Figures and Tables -
Analysis 3.1

Comparison 3 Diagnostic laparoscopy (and open or laparoscopic appendectomy if necessary) versus immediate open appendectomy, Outcome 1 Negative appendectomy (rate).

Comparison 3 Diagnostic laparoscopy (and open or laparoscopic appendectomy if necessary) versus immediate open appendectomy, Outcome 2 Patients with diagnosis not established.
Figures and Tables -
Analysis 3.2

Comparison 3 Diagnostic laparoscopy (and open or laparoscopic appendectomy if necessary) versus immediate open appendectomy, Outcome 2 Patients with diagnosis not established.

Comparison 4 Diagnostic laparoscopy (and open appendectomy if necessary) versus immediate open appendectomy, Outcome 1 Wound infections.
Figures and Tables -
Analysis 4.1

Comparison 4 Diagnostic laparoscopy (and open appendectomy if necessary) versus immediate open appendectomy, Outcome 1 Wound infections.

Comparison 4 Diagnostic laparoscopy (and open appendectomy if necessary) versus immediate open appendectomy, Outcome 2 Intraabdominal abscesses.
Figures and Tables -
Analysis 4.2

Comparison 4 Diagnostic laparoscopy (and open appendectomy if necessary) versus immediate open appendectomy, Outcome 2 Intraabdominal abscesses.

Comparison 4 Diagnostic laparoscopy (and open appendectomy if necessary) versus immediate open appendectomy, Outcome 3 Operation time (minutes).
Figures and Tables -
Analysis 4.3

Comparison 4 Diagnostic laparoscopy (and open appendectomy if necessary) versus immediate open appendectomy, Outcome 3 Operation time (minutes).

Comparison 4 Diagnostic laparoscopy (and open appendectomy if necessary) versus immediate open appendectomy, Outcome 6 Length of hospital stay (days).
Figures and Tables -
Analysis 4.6

Comparison 4 Diagnostic laparoscopy (and open appendectomy if necessary) versus immediate open appendectomy, Outcome 6 Length of hospital stay (days).

Comparison 1. Laparoscopic versus conventional appendectomy in adults

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Wound infections Show forest plot

40

4904

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.45 [0.35, 0.58]

2 Intraabdominal abscesses Show forest plot

40

4953

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.48 [1.45, 4.21]

3 Operation time (minutes) Show forest plot

41

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 Studies reporting mean data

32

3085

Mean Difference (IV, Random, 95% CI)

11.47 [6.90, 16.04]

3.2 Studies reporting median data

11

1937

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Anaesthesia time (minutes) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.2 Studies reporting mean data

1

40

Mean Difference (IV, Random, 95% CI)

6.0 [‐4.86, 16.86]

4.3 Studies reporting median data

2

160

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 Pain intensity on day 1 (cm VAS) Show forest plot

13

Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 Studies reporting mean data

13

1808

Mean Difference (IV, Random, 95% CI)

‐0.87 [‐1.26, ‐0.47]

5.2 Studies reporting median data

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 Length of hospital stay Show forest plot

38

Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 Studies reporting mean data

26

2900

Mean Difference (IV, Random, 95% CI)

‐1.05 [‐1.49, ‐0.62]

6.2 Studies reporting median data

12

1988

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

7 Time until reintroduction of liquid diet (days) Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 Studies reporting means

4

600

Mean Difference (IV, Random, 95% CI)

‐0.50 [‐0.87, ‐0.13]

7.2 Studies reporting medians

1

60

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

8 Time until reintroduction of solid diet (days) Show forest plot

11

Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 Studies reporting means

8

1070

Mean Difference (IV, Random, 95% CI)

‐0.22 [‐0.40, ‐0.04]

8.2 Studies reporting medians

3

220

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

9 Time until first stool (days) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

9.1 Studies reporting means

2

97

Mean Difference (IV, Random, 95% CI)

‐0.31 [‐0.60, ‐0.02]

9.2 Studies reporting medians

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

10 Time until return to normal activity (days) Show forest plot

20

Mean Difference (IV, Random, 95% CI)

Subtotals only

10.1 Studies reporting means

11

1126

Mean Difference (IV, Random, 95% CI)

‐5.86 [‐8.11, ‐3.61]

10.2 Studies reporting medians

9

1733

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

11 Time until return to work (days) Show forest plot

12

Mean Difference (IV, Random, 95% CI)

Subtotals only

11.1 Studies reporting means

5

522

Mean Difference (IV, Random, 95% CI)

0.00 [‐1.97, 1.98]

11.2 Studies reporting medians

7

1303

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

12 Time until return to sport (days) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

12.1 Studies reporting means

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

12.2 Studies reporting medians

2

223

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

13 Cosmesis (cm VAS) Show forest plot

2

623

Mean Difference (IV, Fixed, 95% CI)

‐1.0 [‐1.68, ‐0.32]

13.1 Studies reporting means

1

40

Mean Difference (IV, Fixed, 95% CI)

‐1.0 [‐1.68, ‐0.32]

13.2 Studies reporting medians

1

583

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Costs of the operation Show forest plot

4

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

14.1 Studies reporting mean data

1

37

Std. Mean Difference (IV, Random, 95% CI)

4.55 [3.27, 5.82]

14.2 Studies reporting median data

3

189

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15 Costs within hospital stay (incl. the operation) Show forest plot

7

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

15.1 Studies reporting mean data

3

404

Std. Mean Difference (IV, Random, 95% CI)

0.20 [‐0.29, 0.68]

15.2 Studies reporting median data

4

339

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

16 Costs outside hospital Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

16.1 Studies reporting mean data

1

198

Std. Mean Difference (IV, Random, 95% CI)

‐0.35 [‐0.63, ‐0.07]

16.2 Studies reporting median data

2

96

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Laparoscopic versus conventional appendectomy in adults
Comparison 2. Laparoscopic versus conventional appendectomy in children

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Wound infections (rate) Show forest plot

5

462

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.20 [0.08, 0.54]

2 Intraabdominal abscesses (rate) Show forest plot

5

462

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.97 [0.20, 19.13]

3 Operation time (minutes) Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 Studies reporting mean data

3

193

Mean Difference (IV, Random, 95% CI)

11.09 [6.30, 15.88]

3.2 Studies reporting median data

2

269

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Anaesthesia time (minutes) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Studies reporting mean data

2

150

Mean Difference (IV, Random, 95% CI)

14.26 [5.78, 22.74]

4.2 Studies reporting median data

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 Pain intensity on day 1 (cm VAS) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 Studies reporting mean data

1

61

Mean Difference (IV, Random, 95% CI)

‐0.8 [‐1.65, 0.05]

5.2 Studies reporting median data

1

63

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 Length of hospital stay (days) Show forest plot

3

176

Mean Difference (IV, Fixed, 95% CI)

‐0.61 [1.00, ‐0.23]

6.1 Studies reporting mean data

3

176

Mean Difference (IV, Fixed, 95% CI)

‐0.61 [1.00, ‐0.23]

6.2 Studies reporting median data

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Time until reintroduction of liquid diet (days)

0

Mean Difference (IV, Random, 95% CI)

Subtotals only

8 Time until reintroduction of solid diet (days)

0

Mean Difference (IV, Random, 95% CI)

Subtotals only

9 Time until first stool (days)

0

Mean Difference (IV, Random, 95% CI)

Subtotals only

10 Time until mobilisation (days) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

10.1 Studies reporting mean data

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

10.2 Studies reporting median data

1

58

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

11 Time until return to normal activity (days) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

11.1 Studies reporting mean data

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

11.2 Studies reporting median data

2

157

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

12 Time until return to sport (days) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

12.1 Studies reporting mean data

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

12.2 Studies reporting median data

1

87

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

13 Cosmesis (cm VAS)

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Costs of the operation Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

14.1 Studies reporting mean data

0

0

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.2 Studies reporting median data

1

88

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15 Costs within hospital stay (incl. the operation) Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

15.1 Studies reporting mean data

1

87

Std. Mean Difference (IV, Random, 95% CI)

0.10 [‐0.32, 0.53]

15.2 Studies reporting median data

1

88

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

16 Costs outside hospital

0

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

Figures and Tables -
Comparison 2. Laparoscopic versus conventional appendectomy in children
Comparison 3. Diagnostic laparoscopy (and open or laparoscopic appendectomy if necessary) versus immediate open appendectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Negative appendectomy (rate) Show forest plot

14

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Negative appendectomy rate in unselected adults

8

1327

Risk Ratio (M‐H, Random, 95% CI)

0.37 [0.13, 1.01]

1.2 Negative appendectomy rate in fertile women

6

415

Risk Ratio (M‐H, Random, 95% CI)

0.20 [0.11, 0.34]

2 Patients with diagnosis not established Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Patients with diagnosis not established in unselected adults

4

973

Risk Ratio (M‐H, Random, 95% CI)

0.43 [0.17, 1.08]

2.2 Patients with diagnosis not established in fertile women

6

500

Risk Ratio (M‐H, Random, 95% CI)

0.27 [0.17, 0.44]

Figures and Tables -
Comparison 3. Diagnostic laparoscopy (and open or laparoscopic appendectomy if necessary) versus immediate open appendectomy
Comparison 4. Diagnostic laparoscopy (and open appendectomy if necessary) versus immediate open appendectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Wound infections Show forest plot

3

223

Peto Odds Ratio (Peto, Fixed, 95% CI)

7.54 [0.47, 122.28]

2 Intraabdominal abscesses Show forest plot

3

223

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.14 [0.01, 2.16]

3 Operation time (minutes) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 Studies reporting mean data

2

163

Mean Difference (IV, Random, 95% CI)

‐2.62 [‐15.62, 10.38]

3.2 Studies reporting median data

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Anaesthesia time (minutes)

0

Mean Difference (IV, Random, 95% CI)

Subtotals only

5 Pain intensity on day 1 (cm VAS)

0

Mean Difference (IV, Random, 95% CI)

Subtotals only

6 Length of hospital stay (days) Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 Studies reporting mean data

4

273

Mean Difference (IV, Random, 95% CI)

‐0.16 [‐1.03, 0.71]

6.2 Studies reporting median data

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 4. Diagnostic laparoscopy (and open appendectomy if necessary) versus immediate open appendectomy