Thirty-nine RCTs (5,896 patients) were included in the review. Two RCTs scored a maximum of 5 points for quality, two scored 4 points, 25 scored 3 points and 10 scored 2 points.
Compared with open surgery, laparoscopic surgery was associated with a longer operative time (WMD 13.12 minutes, 95% CI 9.72 to 16.61; 36 RCTs). There was evidence of substantial statistical heterogeneity (I²=96%).
Compared with open surgery, laparoscopic surgery was associated with earlier resumption of liquid intake (WMD 4.58 hours, 95% CI 7.18 to 1.99; eight RCTs), and solid intake (WMD 6.57 hours, 95% CI 9.55 to 3.60; 10 RCTs), shorter duration of postoperative hospital stay (WMD 0.79 hours, 95% CI 1.06 to 0.52; 33 RCTs), and a reduction in number of doses of parenteral analgesics (WMD 0.90, 95% CI 1.28 to 0.51; 14 RCTs) and number of doses of oral analgesics (WMD 1.51, 95% CI 2.63 to 0.38; eight RCTs). There was evidence of significant statistical heterogeneity with analyses reporting I² >90%.
There were significantly fewer wound infections with laparoscopic surgery compared to open surgery (OR 0.46, 95% CI 0.34 to 0.62; 32 RCTs; I²=9%). Laparoscopic surgery was also associated with faster return to normal activity and return to work compared to open surgery, and fewer patients had a problem with the cosmetic appearance of the wound scar. There were no significant differences between interventions for postoperative complications including mortality, intra-abdominal abscess, pulmonary infection, shoulder pain, venous thromboembolism or postoperative ileus (details not reported in article).