Laparoscopic versus open appendectomy for appendicitis in children: a systematic review and meta-analysis

Abstract

Acute appendicitis is among the most common pediatric surgical emergencies worldwide. Laparoscopic appendectomy (LA) has gained wide acceptance in recent years ; however, its superiority over the traditional open appendectomy (OA) is still a topic of debate, particularly regarding postoperative outcomes and recovery. This systematic review and meta-analysis aimed to compare LA and OA in children with acute appendicitis, focusing on postoperative outcomes, recovery parameters, pain, cosmetic results, and cost-effectiveness to guide evidence-based surgical decision-making. The study followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42025620445). A comprehensive search was conducted in PubMed, Embase, Science Direct, Scopus, and Google Scholar in November 2024. Randomized controlled trials and observational studies comparing LA and OA in patients aged ≤ 18 years were included. Data were extracted and analyzed using RevMan 5.0, applying fixed- or random-effects models according to heterogeneity. Twenty-five studies involving 166,755 patients (7 RCTs and 18 observational studies) were included. LA significantly reduced surgical site infection (OR = 0.68), intestinal obstruction (OR = 0.24), and reoperation rate (OR = 0.53). It also shortened hospital stay (MD = − 1.16 days) and time to oral intake (MD = − 1.14). No significant differences were found in operative time, intra-abdominal abscess formation, or overall complications. LA offers better postoperative outcomes and faster recovery than OA in pediatric appendicitis, with comparable operative time and abscess risk. These findings support LA as the preferred approach, although further multicenter RCTs are needed for long-term outcome validation.