Four RCTs (n=811, range 65 to 522) were included in the review. The quality score was 1 for all four studies.
Compared with active observation, early laparoscopy significantly reduced the number of patients discharged without a final diagnosis (OR 0.13, 95% CI 0.03 to 0.51; four studies). The early laparoscopy group reported fewer complications (three studies), fewer readmissions (two studies) and a modest reduction in length of hospital stay (three studies); these findings were not statistically significant. There was significant heterogeneity across all four comparisons.