Efficacy Meta-analysis Of Endoscopic Retrograde Appendicitis Therapy And Laparoscopic Appendectomy In The Treatment Of Acute Uncomplicated Appendicitis

Objective:To compare the efficacy of endoscopic retrograde appendicitis therapy(ERAT)and laparoscopic appendectomy(LA)in the treatment of acute uncomplicated appendicitis.Methods:Randomized controlled trials or controlled clinical trials that compared the efficacy of ERAT and LA which used in the treatment of acute uncomplicated appendicitis were searched from three English databases,PubMed,Embase,Cochrane and three Chinese databases,CNKI,Wanfang database,SinoMed before March 2018.The literature was screened strictly,and the quality of the literature were assessed and valid data were extracted.Finally,a meta-analysis was performed using RevMan 5.3 software for the operative time,postoperative body temperature recovery time,white blood cells recovery time,postoperative bed rest time,duration of hospital stays,and operative complication rate for both groups.Results:1.The baseline characteristics of the selected studies:Five studies with a total of 303 patients(152 in ERAT group and 151 in LA group)were included in our study.The terms of sex,age between two groups were without statistical differences(all P > 0.05).2.Comparison of operative time in two groups:the operative time of the ERAT group was shorter than that of the LA group(WMD=-19.61,95% CI:-24.93~-14.23,P<0.00001).3.Comparison of postoperative body temperature recovery time in two groups:there was no statistically significant difference between the ERAT group and the LA group in postoperative body temperature recovery time(WMD=-0.99,95% CI:-1.48~-0.50,P<0.0001).4.Comparison of white blood cells recovery time in two groups:there was no statistically significant difference in white blood cells recovery time between the ERAT group and the LA group(WMD=-1.21,95% CI:-2.51~0.10,P=0.07).5.Comparison of postoperative bed rest time in two groups:the postoperative bed rest time in the ERAT group was shorter than that in the LA group(WMD=-1.82,95% CI:-2.45~-1.19,P<0.00001).6.Comparison of duration of hospital stays in two groups:the duration of hospital stays in the ERAT group was shorter than that in the LA group(WMD=-2.23,95% CI:-3.15~-1.30,P<0.00001).7.Comparison of operative complication rate in two groups:the operative complication rate in the ERAT group was lower than that in the LA group(OR=0.27,95% CI:0.11~0.67;P=0.005).Conclusions:1.The use of ERAT in the treatment of acute uncomplicated appendicitis can shorten the operative time,accelerate postoperative body temperature recovery time,reduce postoperative bed rest time and duration of hospital stays,and reduce the operative complication rate.2.There was no statistically significant difference in white blood cells recovery time between the ERAT group and the LA group.In summary,from our research,ERAT is safe and effective in the treatment of acute uncomplicated appendicitis patients,but due to the limitations of the study,it still needs to wait for multi-center participation in high-quality large samples and randomized clinical control study data to provide a theoretical basis.