Randomized controlled trial comparing clinical outcome and cost analysis between laparoscopic and open appendicectomy for acute appendicitis at Dharan, Sunsari, Nepal

Abstract

Background: Acute appendicitis is the most common etiology of acute abdomen, generally requiring urgent surgical intervention, with a lifetime incidence between 7 and 9%. With the experience in minimal invasive surgery, laparoscopy has advantage of being both diagnostic and therapeutic. In developing country like Nepal, with limited health resources, the trend of laparoscopic appendicectomy (LA) is emerging. This study was conducted to determine difference in clinical outcome and cost analysis between laparoscopic (LA) and open appendicectomy (OA).Methods: This study was Randomized Controlled Trial conducted in the Department of Surgery, B.P. Koirala Institute of Health Sciences (BPKIHS), a tertiary care hospital in Eastern Nepal, over a period of twelve months from January 2017 to December 2017. Ethical clearance was obtained from Institutional Review Committee (IRC). The study population were adults with clinical diagnosis of acute appendicitis fulfilling inclusion and exclusion criteria.Results: In this study, 47% patients were male and 53% were female in LA and 58.8% patients were male and 41.2% were female in OA ; the mean age was 24.6 years in LA and 27.7 years in OA ; mean operation time was more in LA than in OA i.e. 70 minutes and 57 minutes respectively (p value 0.001); mean hospital stay was more for OA (3.6 days) as compared to LA (3.06 days), (p value 0.125) ; The number of analgesic injections during postoperative period in two groups was 5.52±0.99 for LA, 5.62±1.02 for OA (p value 0.626); infection rate was 1% in LA, 6% in OA; The cost of surgery was higher in case of LA (NRs 15067.04) than in OA (NRs. 12524).Conclusions: OA had statistically significant lower pain in 1st three postoperative periods, and a shorter hospital stay, early postoperative recovery but a slightly higher cost per discharge than OA.