SCALPEL OR SCOPE? A META-ANALYSIS OF LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN LOW AND MIDDLE-INCOME COUNTRIES. dr.aliyasen1@gmail.com

 

SCALPEL OR SCOPE? A META-ANALYSIS OF LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN LOW AND MIDDLE-INCOME COUNTRIES.

6

United Kingdom

Oral or Poster

This study aims to compare perioperative and postoperative outcomes between laparoscopic (LA) and open (OA) in Low and Middle-Income Countries (LMIC)

A systematic online search was conducted using electronic databases, including PubMed, Embase, Scopus, and regional databases for studies comparing LA and OA in LMICs. LIMICs were identified according to the World Bank classification. The primary outcomes were return to normal daily activity and length of hospital stay (LOS) and operative time and postoperative complications were secondary outcomes. Risk of bias was assessed using the Cochrane RoB2 or Newcastle–Ottawa Scale, as appropriate. Meta-analysis was performed using a random-effects model with 95% confidence intervals.

Thirty-four studies involving 4,906 patients (LA= 2,432, OA= 2,474) from ten LMICs were eligible for inclusion. The LA group showed significantly shorter LOS and return to daily activity in comparison to OA [mean difference (MD)=-1.07,P=0.00001] and (MD -3.84,P=0.00001) (Figure 1), respectively. Moreover, the LA group was superior in terms of surgical site infection (P=0.0001), postoperative ileus (P=0.04) and postoperative pain (P=0.0005). Compared to LA, OA showed shorter operation time (P=0.01); however, there was no difference between the two groups regarding abdominal collection (P=0.44) and re-operation (P=0.39).

In LMICs, LA offers faster recovery and fewer complications compared with OA, albeit with a longer operative time. LOS and return to daily activity are particularly crucial in LMICs, where healthcare resources and patient socioeconomic factors make early discharge and rapid functional recovery highly beneficial. Where resources permit, LA should be considered the preferred technique.