Twelve studies were included. There was one RCT (104 participants) and 11 CCTs: three prospective (437 participants, range 46 to 332) and eight retrospective (993 participants, range nine to 271). The RCT scored the maximum 5 points for quality. The CCTs scored from 3 to 7 points out of 10; their most common weakness was lack of comparability of the two groups.
In the RCT there was no significant difference between the groups in mortality. There was only one death in the study which was in the open surgery group (zero out of 52 versus one out of 52). The laparoscopic group had lower rates of overall morbidity (42.3% versus 53.8%) and of major complications (9.6% versus 25%). Minor complication rates were similar (36.5% versus 38.5%).
Mortality was also low in the CCTs and did not differ significantly between the laparoscopic and open surgery groups (two out of 530 versus four out of 736; OR 1.15, 95% CI 0.24 to 5.57; 10 studies; Ι²=0%). The laparoscopic group had lower rates of overall morbidity (16.84% versus 27.1%; OR 0.46, 95% CI 0.25 to 0.84; 11 studies; Ι²=74%) and of minor complications (9.1% versus 18.4%; OR 0.37, 95% CI 0.18 to 0.78; nine studies; Ι²=55%). Major complication rates did not differ between the groups (9.5% versus 13.5%; OR 0.73, 95% CI 0.34 to 1.54; 10 studies; Ι²=66%). As evident from the Ι² values, there was high heterogeneity for analyses of morbidity and complications.
Other findings were reported in the review.