Six studies (five retrospective and one prospective) were included in the review of 15,852 patients (4,398 patients received laparoscopic and 11,454 open appendectomy).
Postoperative mortality was lower for laparoscopic compared to open appendectomy with low heterogeneity (OR 0.24; 95% CI 0.15 to 0.37; four studies; Ι²=0%). Postoperative complications were also lower in laparoscopic compared with open appendectomy (OR 0.61; 95% CI 0.50 to 0.73; six studies; Ι²=49%) with some heterogeneity but this was not considered statistically significant.
For the secondary outcomes, length of stay was less for the laparoscopic appendectomy group by approximately half a day (MD -0.51; 95% CI -0.64 to -0.37; four studies Ι²=18%). There were no statistically significant differences on any other secondary outcomes (operative time, intra-abdominal collection and postoperative wound infection).
There was no evidence to indicate publication bias. Subgroup analyses did not find evidence that outcomes differed according to incidence of appendiceal perforation.