LAPAROSCOPIC AND OPEN APPENDECTOMY

Abstract

Objectives: Objectives of this study are to compare the outcome of thelaparoscopic with open appendectomy in terms of postoperative pain, postoperativecomplications and hospital stay. Study Design: Randomized control trial. Place and Periodof Study: This study was held in Surgical Unit-III, Liaquat University Hospital Jamshoro, fromSeptember 2013 to March 2014. Methodology: This study comprised of sixty patients admittedvia outpatient department, and also through casualty department of LUHMS Jamshoro/Hyderabad. Cases were categorized into 2 groups. Group-A for open appendectomy andgroup-B for laparoscopic appendectomy. Comprehensive History was obtained from eachpatient. Right iliac fossa site was particularly assessed for tenderness assessment at Mc: Burney’spoint rigidity rebound tenderness and documented through proforma. A comprehensive reviewwas as well performed to observe any co-morbidity. Inclusion criteria comprised of all thosepatients of acute appendicitis who give written consent for study after counseling, irrespectiveof their age and sex. Criteria for exclusion included each patient with aspects of specifiedperitonitis, cases with obvious mass within right iliac fossa as well as cases with pre-operativehistory of lower abdomen or caesarean section. Outcomes were documented in the term ofterms of postoperative pain, postoperative complications and hospital stay and recorded onPerforma. Data analyzing was carried out with SPSS software. Results: From totally 60 casesin our study 40 patients males (66.67%) and 20 were females (33.33%); with female to maleproportion of 1:3. There was an extensive variation in age from 10 to 70 years among bothgroups. The mean age was 26.78 years. Both groups were symptomatically nearly similar withpain in RIF, pain initiating around umbilicus, nausea, vomiting, anorexia, fever, and modifiedbowel 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’spoint in 59 (98.33%) cases, muscle guarding in 52 (86.67%) cases, rebound tenderness in55 (91.67%) cases and fever in 20 (33.33%) patients. Operative period in each group wasdocumented that ranged from 30 to 90 min. in each group. The mean operative period in OAgroup was 38.90+15.90 where as it was 26.30+12.96 minutes LA group. Post-operative painseverity in each group was documented. Mild pain was found in 5(16.67%) in OA group casesand 21 (70%) in LA group cases was noted, moderate pain in 22(73.33%) OA group casesand 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 (mean14.8 days) as contrasted to laparoscopic appendectomy (LA) group where it varied from 7-15days. Conclusion: In conclusion, we exhibited that LA has significant