Title: A Study of Open Versus Laparoscopic Appendicectomy in Government Medical College
Authors: Dr Lalan Kumar, Dr Manish, Dr A.P. Singh
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.158
Abstract
Objective: The authors compare open and laparoscopic appendicectomy in a randomized fashion with regard to length of operation, complications, hospital stay, and recovery time.
Methods: Adult patients (older than 16 years of age) with the diagnosis of acute appendicitis were randomized to either open or laparoscopic appendicectomy from October 2013 to December 2016 in Government Medical College Bettiah. All patients received preoperative antibiotics. The operative time was calculated as beginning with the incision and ending when the wound was fully closed. Patients that were converted from laparoscopic to open appendicectomy were considered a separate group. Return to normal activity and work were determined by questioning during postoperative out-patients department (OPD).
Results: There was a total of 312 patients randomized, 162 to the open and 150 to the laparoscopic group. The groups were similar demographically. Of the 150 laparoscopic patients, 24 (16%) were converted to open. In the open group, 130 patients (80.24%) had acute appendicitis and 32 (19.75%) had perforative appendicitis. In the laparoscopic group, 115 patients (76.6%) had acute appendicitis and 18 (12%) had perforative appendicitis. There was no statistical difference in the return to activity or work between the laparoscopic and open groups. The operative time was significantly longer in the laparoscopic group (72.8 minutes vs. 55.4 minutes, p < 0.01). The hospital stay of 2.3 days in the laparoscopic group and 4.5 days in the open group was statistically different (p = 0.007). There was no difference in the hospital stay for those with acute appendicitis (1.95 days vs. 2.69 days, p = 0.067) compared with those with a normal appendix but with pelvic inflammatory disease (1.3 days vs. 2.1 days, p = 0.11 ). There was a significant difference in patients with perforative appendicitis (2days vs. 10 days, p < O.01). There were no increased complications associated with the laparoscopic technique.
Conclusion: Laparoscopic appendicectomy is comparable to open appendicectomy with regard to complications, hospital stay, return to activity, and return to work. There was a greater operative time involved with the laparoscopic technique. Laparoscopic appendicectomy does not offer any significant benefit over the open approach for the routine patient with appendicitis.
Laparoscopic techniques have been used therapeutically for a variety of intra-abdominal problems and is accepted treatment for cholelithiasis. 3 It is surprising that the first reported laparoscopic appendicectomy was done in 1982 and the efficacy and indication for this procedure are still debated. . We undertook this prospective randomized evaluation of open versus laparoscopic appendicectomy to clarify the use of this technique.
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