Al‐Mulhim 2002.

Methods	Design of RCT: parallel clinical trial                                                      Power calculation: not stated                                                      No blinding used                                                           Follow‐up at four weeks                                                        60 participants recruited, 60 randomly assigned                                                      No data about participants excluded before random assignment                                                      Lost to follow‐up: no data on number of participants seen at four weeks' follow‐up                                      60 women analysed                                                      Single centre: King Fahad Hospital, Hofuf, Al‐Hassa, Kingdom of Saudi Arabia      Enrolment between January 1999 and April 2000                                                        Source of funding: not provided         Ethical issues: consent form obtained for each participant   Method to establish definitive diagnosis: visual examination of appendix and abdominal cavity and histopathological examination of appendix in laparoscopic group. Not clearly stated but in all participants appendix removed and sent for histopathological study in conventional group
Participants	Women with clinical diagnosis of acute appendicitis                                                       Included: patients with clinical diagnosis of acute appendicitis, patients suitable for a right iliac fossa muscle‐splitting approach to the appendix, patients suitable for laparoscopy with no evidence of pregnancy                                         No exclusion criteria stated                                                           Mean age (SD): 23 years (14 to 35) in laparoscopy group, 26 years (14 to 42) in conventional group                                                     Weight: 54 kg (30 to 82) in laparoscopy group, 58 kg (35 to 90) in conventional group                                                  Mean serum white cell count: 12.8 (6.2 to 18.3) in laparoscopy group, 14.5 (8.2 to 19.6) in conventional group                 "Time of evolution of symptoms, median (range): 20 (6‐72) in laparoscopy group, 4 days (1‐80) in conventional group . of the pain (SD): 22.1 (± 5) in laparoscopy group, 21.5 (± 3) in the conventional group"
Interventions	Laparoscopic appendicectomy versus open appendicectomy                                                 Laparoscopic appendicectomy (group 1): three stab incisions required (a small midline incision was made at the umbilicus and a 10‐mm trocar was inserted, camera was inserted at this site); 5‐mm trocar below right costal margin and another five mm in the left iliac fossa of the abdomen placed under direct vision  Open appendicectomy (group 2): carried out through a muscle‐splitting incisor in the right iliac fossa     Surgeons participating in this study experienced in laparoscopic surgery; a Registrar with long general surgery experience usually performed open appendicectomy                                                      Non‐inflamed appendix removed at both laparoscopic and open surgery, even when a definitive cause of the participant's symptoms was found. Postoperative pain control for both groups: pethidine 1 g/kg every six hours if needed for the first 24 hours, then shifted to intramuscular Voltaren 75 mg per request. Discharge pain medicine: paracetamol tablets
Outcomes	Pathology findings: reported                                                      "Operating time (minutes)": stated in methods and reported                                                       Control of pain: number of doses of pethidine and Voltaren stated in methods and reported              Mobilisation from bed: stated in methods and reported                                                  Reintroduction of liquid and solid diet: stated in methods and reported                                                    Return to normal activity: stated in methods and reported                                    Complications: stated in methods and reported
User defined 1
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Text: states that participants were randomly assigned
Allocation concealment (selection bias)	Unclear risk	Text: states that a sealed envelope system was used
Blinding (performance bias and detection bias) All outcomes	High risk	Open RCT
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Not clear whether follow‐up was similar in the two groups. No loss to follow‐up reported
Selective reporting (reporting bias)	Unclear risk	Protocol of the study not available
Free of differential verification bias	Unclear risk	Definitive diagnosis not done with the same reference standard in the two groups
Free of partial verification bias	Unclear risk	Non‐random set of participants not undergoing the reference standard
Free of Incorporation Bias	Unclear risk	Index test incorporated as the reference standard in the laparoscopic group
Other bias	Low risk	Baseline characteristics reported