Source: Surgical Endoscopy and Other Interventional Techniques; Jun 2017; vol. 31 (no. 2)
Publication Date: Jun 2017
Publication Type(s): Conference Abstract
Abstract:Aim: To investigate the relative effectiveness and provide a treatment ranking of different options for securing the appendix stump in laparoscopic appendectomy. Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) comparing ligation methods of the appendix including endoloop, laparoscopic suture, endoclip or endoscopic stapler to open appendectomy, single-incision appendectomy, needlescopic appendectomy, or conservative treatment. The primary outcomes were organ/space infection and superficial surgical site infection. We performed a network meta-analysis and we estimated the pairwise relative treatment effects of the competing interventions using the odds ratio (OR) and its 95% confidence interval (CI). We R) lot suggests f incosistency between direct and indirect comparisons. in erval plot suggests obtained a hierarchy of the competing interven-tions using rankograms and the surface under the cumulative ranking curve (SUCRA). Results: Forty-three RCTs were eligible and provided data for more than 5000 patients. Suture ligation appeared to be the most effective treatment strategy, in terms of both organ/space infection and superficial surgical site infection, according to the estimated relative effects and SUCRA values. Statistical significance was reached for the comparisons of clip vs. endoloop (OR 0.56, 95% CI 0.32 to 0.96) for organ/space infection; and suture vs. clip (OR 0.20, 95% CI 0.08 to 0.55) and clip vs. endoloop (OR 2.22, 95% CI 1.56 to 3.13) for superficial surgical site infection. There was considerable uncertainty on these outcomes, because the rarity of events generally resulted in wide interval estimates. Furthermore, the network was informed primarily by indirect treatment comparisons. However, there was no evidence of incosistency between direct and indirect comparisons, but this could be masked, due to the spareness of events. Conclusions: The use of suture ligation of the appendix in laparo-scopic appendectomy seems to be superior to other methods for the composite parameters of organ/space and superficial surgical site infection.