From the Guidelines
The CODA trial is not directly mentioned in the provided evidence, however, based on the most recent and highest quality study, laparoscopic appendectomy is the preferred approach for most patients with acute appendicitis, including those with complicated appendicitis, due to its association with less postoperative pain, shorter length of stay, and earlier return to work and physical activity 1.
Key Findings
- Laparoscopic appendectomy (LA) has been shown to have significant benefits compared to open appendectomy (OA), including less postoperative pain, shorter length of stay, and earlier return to work and physical activity 1.
- The evidence regarding treatment effectiveness of LA versus OA in terms of postoperative intra-abdominal abscess (IAA) has changed over the last decade, with more recent trials showing no significant difference in IAA rates between LA and OA 1.
- LA appears to have significant benefits with improved morbidity compared to OA in complicated acute appendicitis, with reduced surgical site infections, time to oral intake, and length of hospitalization 1.
Recommendations
- Laparoscopic appendectomy should be the preferred approach for most patients with acute appendicitis, including those with complicated appendicitis, due to its association with improved outcomes and reduced morbidity 1.
- Patients should be informed of the potential benefits and risks of LA, including the possibility of increased operative time and higher operative costs, as well as the potential for increased risk of IAA.
- The decision to perform LA or OA should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances, as well as the availability of resources and technical expertise.
From the Research
Results of the CODA Trial Regarding Appendectomy
There are no research papers provided that directly discuss the results of the CODA (Comparison of Outcomes of Drainage and Appendectomy) trial regarding appendectomy.
Available Evidence on Appendectomy
However, several studies have compared the outcomes of laparoscopic and open appendectomy:
- A prospective study published in 2025 2 found that laparoscopic appendectomy offered several advantages over open appendectomy, including shorter hospital stay, better postoperative pain recovery, and earlier return to normal activities.
- A prospective comparative study published in 2016 3 found that laparoscopic appendectomy had a lower incidence of wound infection, lesser postoperative analgesic requirement, and shorter hospital stay compared to open appendectomy.
- A national cohort study published in 2014 4 found that laparoscopic appendectomy was associated with a shorter length of hospital stay, lower frequency of negative appendicectomy, and lower rates of wound infection and wound rupture, but higher rates of intestinal injury and postoperative abdominal abscess.
- A meta-analysis published in 2011 5 found that laparoscopic appendectomy had advantages over open appendectomy, including fewer postoperative complications, less pain, earlier start of liquid diet, shorter hospital stay, and earlier return to work and normal activity.
- A retrospective observational study published in 2011 6 found that laparoscopic appendectomy resulted in significantly better surgical outcomes for uncomplicated appendicitis and comparable but not significantly reduced hospital costs, while for complicated or perforated appendicitis, laparoscopic appendectomy showed lower mortality, reduced overall morbidity, and reduced hospital costs.
Key Findings
Some key findings from these studies include:
- Laparoscopic appendectomy is associated with shorter hospital stay and better postoperative recovery compared to open appendectomy 2, 3, 5.
- Laparoscopic appendectomy has a lower incidence of wound infection and wound rupture, but a higher rate of intestinal injury and postoperative abdominal abscess 4.
- Laparoscopic appendectomy is superior or comparable to open appendectomy in terms of several surgical outcome measures for both uncomplicated and complicated appendicitis 6.