Complicated appendicitis is associated with a higher risk of postoperative complications, including adhesive bowel obstruction. The aim of this meta-analysis is to investigate the difference in rates of postoperative bowel obstruction in paediatric patients with complicated versus simple appendicitis and whether this is influenced by the surgical approach. A systematic literature search following PRISMA guidelines was conducted using MEDLINE, Embase and Cochrane Library for studies that analysed incidence of adhesive bowel obstruction in paediatric patients after appendicectomy. Studies from 1998 to 2022 were included in analysis. The study protocol was registered on PROSPERO (ID CRD42022309769). Pooled analysis of 6 studies with low risk of bias and adequate follow up periods, considering 58,962 cases of appendicectomy, revealed complex appendicitis was associated with a near two-fold increase in incidence of SBO (pooled odds ratio 2.02 (95% CI 1.35–2.69)). Interestingly, a similar pooled analysis of 10 studies, considering 62,433 cases of appendicectomy, revealed no significant difference between open and laparoscopic management of complex appendicitis (pooled odds ratio 0.93 (95% CI 0.24 to 1.62)). Complex appendicitis is associated with a two-fold increase in the rates of adhesive bowel obstruction. Whilst there are cosmetic advantages of a laparoscopic approach, surgical expertise should be favoured in decision making relating to surgical approach (laparoscopic versus open) as the evidence for a laparoscopic approach reducing risks of adhesive bowel obstruction is not convincing. Level II.

中文翻译：

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阑尾炎儿童粘连性肠梗阻的风险：系统评价

复杂性阑尾炎与术后并发症（包括粘连性肠梗阻）的较高风险相关。本荟萃分析的目的是调查复杂性阑尾炎儿科患者与单纯性阑尾炎儿科患者术后肠梗阻发生率的差异，以及这是否受到手术方法的影响。根据 PRISMA 指南，使用 MEDLINE、Embase 和 Cochrane 图书馆进行系统文献检索，以分析儿科患者阑尾切除术后粘连性肠梗阻的发生率。 1998 年至 2022 年的研究纳入分析。该研究方案已在 PROSPERO 上注册（ID CRD42022309769）。对 6 项偏倚风险低且随访时间充足的研究进行汇总分析，考虑了 58,962 例阑尾切除术，结果显示复杂性阑尾炎与 SBO 发生率增加近两倍相关（汇总比值比 2.02（95% CI 1.35-2.69） ））。有趣的是，对 10 项研究进行的类似汇总分析（考虑了 62,433 例阑尾切除术）显示，复杂阑尾炎的开腹和腹腔镜治疗之间没有显着差异（汇总优势比为 0.93（95% CI 0.24 至 1.62））。复杂性阑尾炎与粘连性肠梗阻的发生率增加两倍相关。虽然腹腔镜入路具有美容优势，但在与手术入路（腹腔镜与开腹）相关的决策中应优先考虑外科专业知识，因为腹腔镜入路降低粘连性肠梗阻风险的证据并不令人信服。二级。