Discordant outcomes of laparoscopic versus open appendectomy for suspected appendicitis during pregnancy in published me
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and Other Interventional Techniques
REVIEW ARTICLE
Discordant outcomes of laparoscopic versus open appendectomy for suspected appendicitis during pregnancy in published meta‑analyses: an overview of systematic reviews Goran Augustin1 · Matija Boric2 · Ognjen Barcot2 · Livia Puljak3 Received: 9 March 2020 / Accepted: 23 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objectives Our study aimed to explore the discrepancy of results between overlapping systematic reviews (SRs) of laparoscopic appendectomy (LA) versus open appendectomy (OA) for suspected appendicitis during pregnancy. Methods MEDLINE, Embase, and Cochrane Database of Systematic Reviews (CDSR) were searched for SRs published from January 1, 2017 to September 10, 2019. SRs and meta-analyses (MA) that compared outcomes of LA versus OA during pregnancy were used. Data regarding the methodology of SR/MA, included studies, efficacy and safety outcomes were extracted. SR quality was analysed with AMSTAR 2. Results Four SRs were found, published between April 2018 and April 2019. These reviews included a variety of primary studies, ranging from 17 to 22, and number of included patients varied from 4694 to 6276. A total of 13 outcomes were analyzed. Nine outcomes were included in more than one review; among them, discrepancies between summary effect sizes in meta-analyses were found in four outcomes: preterm birth, Apgar score at 5 min, length of stay in hospital, and wound infection rates. One primary study, which included more than half of the total number of patients in analyzed reviews, showed a predominant effect on the outcome for fetal loss. All four SRs had critically low methodological quality. Conclusions The outcomes of LA versus OA for suspected appendicitis in pregnancy represented in four recent SRs do not provide consistent results. Such uncertainties require new, high-quality primary and secondary evidence on this topic. Keywords Acute appendicitis · Appendectomy · Pregnancy · Systematic review · Meta-analysis · Discordance Acute appendicitis (AA) commonly requires surgical intervention [1]. A systematic review (SR) of randomized controlled trials (RCTs) from 2011 showed that conservative
Goran Augustin, Matija Boric, and Ognjen Barcot have contributed equally. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07674-6) contains supplementary material, which is available to authorized users. * Matija Boric [email protected] 1
Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
2
Department of Surgery, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
3
Center for Evidence‑Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
treatment may reduce complication rates in the general population with AA, but the efficacy of surgery was significantly higher [2]. Various reviews of AA incidence in pregnancy have been reported as 1:181 [3], 1:1500 [4], and 1:5
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