368 Peritoneal Closure Versus Non-Closure in Open Appendectomy: A Systematic Review and Meta Analysis of Postoperative Outcomes

Abstract

Abstract Aim Acute appendicitis is one of the most common surgical emergencies, with open appendectomy remaining a standard treatment approach in many countries. Peritoneal closure during the procedure has been traditionally performed to minimize postoperative complications as some surgeons want to preserve the anatomy of the abdomen. However, recent evidence challenges this convention, suggesting that non-closure may offer benefits such as reduced postoperative pain. This systematic review and meta-analysis aimed to assess the comparative outcomes of peritoneal closure versus non-closure during open appendectomy. Method A comprehensive literature search of studies published between 2012 and 2024 was conducted, focusing on clinical trials. Eight studies involving a total of 938 patients were included. Outcomes assessed included postoperative pain, operative time, analgesic requirements, and complications such as wound infections and adhesions. Meta-analytical techniques were employed to calculate effect sizes and statistical significance. Results The pooled analysis revealed that non-closure of the peritoneum significantly reduced postoperative pain, with an average reduction of 0.937 points on the VAS (95% CI, 0.402–1.472; p < 0.001). Operative time was also significantly shorter in the non-closure group, with an average reduction of 0.926 minutes (95% CI, 0.519–1.333; p < 0.001). Additionally, patients in the non-closure group required fewer analgesics during the immediate postoperative period. These findings align with prior evidence from gynecological and obstetric surgeries, supporting the clinical benefits of non-closure. Conclusions Non-closure of the peritoneum during open appendectomy offers several clinical advantages without increasing the risk of complications. These results suggest that non-closure is a viable alternative to traditional peritoneal closure.