LAPAROSCOPIC AND OPEN APPENDECTOMY

COMPARATIVE OUTCOME

Abstract

Objectives: Objectives of this study are to compare the outcome of the
laparoscopic with open appendectomy in terms of postoperative pain, postoperative
complications and hospital stay. Study Design: Randomized control trial. Place and Period
of Study: This study was held in Surgical Unit-III, Liaquat University Hospital Jamshoro, from
September 2013 to March 2014. Methodology: This study comprised of sixty patients admitted
via outpatient department, and also through casualty department of LUHMS Jamshoro/
Hyderabad. Cases were categorized into 2 groups. Group-A for open appendectomy and
group-B for laparoscopic appendectomy. Comprehensive History was obtained from each
patient. Right iliac fossa site was particularly assessed for tenderness assessment at Mc: Burney’s
point rigidity rebound tenderness and documented through proforma. A comprehensive review
was as well performed to observe any co-morbidity. Inclusion criteria comprised of all those
patients of acute appendicitis who give written consent for study after counseling, irrespective
of their age and sex. Criteria for exclusion included each patient with aspects of specified
peritonitis, cases with obvious mass within right iliac fossa as well as cases with pre-operative
history of lower abdomen or caesarean section. Outcomes were documented in the term of
terms of postoperative pain, postoperative complications and hospital stay and recorded on
Performa. Data analyzing was carried out with SPSS software. Results: From totally 60 cases
in our study 40 patients males (66.67%) and 20 were females (33.33%); with female to male
proportion of 1:3. There was an extensive variation in age from 10 to 70 years among both
groups. The mean age was 26.78 years. Both groups were symptomatically nearly similar with
pain in RIF, pain initiating around umbilicus, nausea, vomiting, anorexia, fever, and modified
bowel behavior, in 59 (98.33%), 45 (75%), 50 (83.33%), 35 (58.33%), 25 (41.67%), 22 (36.67%),
20 (33.33%) respectively. Clinical assessment of cases exposed tenderness at Mc Burney’s
point in 59 (98.33%) cases, muscle guarding in 52 (86.67%) cases, rebound tenderness in
55 (91.67%) cases and fever in 20 (33.33%) patients. Operative period in each group was
documented that ranged from 30 to 90 min. in each group. The mean operative period in OA
group was 38.90+15.90 where as it was 26.30+12.96 minutes LA group. Post-operative pain
severity in each group was documented. Mild pain was found in 5(16.67%) in OA group cases
and 21 (70%) in LA group cases was noted, moderate pain in 22(73.33%) OA group cases
and 9(30%) LA group cases was noted, severe pain was described by 3 (10%) patients in OA.
The period of return to normal activity in open appendectomy ranged from 7-25 days (mean
14.8 days) as contrasted to laparoscopic appendectomy (LA) group where it varied from 7-15
days. Conclusion: In conclusion, we exhibited that LA has significant