Laparoscopic Appendectomy Group Research Articles

Laparoscopic Appendectomy in Children: Tunisian Experience.

The purpose of this study is to compare the surgical outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) for pediatric acute appendicitis in order to guide its future management. We conducted a retrospective study including all children under the age of 14 years, who underwent appendectomy for acute appendicitis, during a period of 6 years (2013-2018). We divided our patients in two groups based on the surgical modality: the laparoscopic and open group. P values of less than .05 were considered statistically significant. A total of 690 appendectomies were identified: 151 (22%) were performed laparoscopically and 539 (78%) via laparotomy. The demographic data were comparable between the 2 groups. There was no statistical difference regarding the age, sex. However the frequency of obese patients was higher in laparoscopic approach (P < .001).The mean operative time was significantly longer in the Laparoscopic group (77 ± 39, 6 minutes) compared with Open group (57 ± 27 minutes) (P < .001). Prophylactic drain placement was significantly more common in the open appendectomy group (P = .034). Patients undergoing laparoscopic appendectomy experienced a quicker recovery to apyrexia, reduced use of postoperative analgesics, and postoperative antibiotic compared to those undergoing open appendectomy (P < .05). The mean length of hospital stay was respectively 4 ± 1 day in LA group and 4 ± 2 days in the OA group. No significant difference was observed. The results showed no significant difference between the 2 groups regarding the incidence of wound infection, intra abdominal abscess, intestinal obstruction and umbilical hernia (P > .05).There was no death in this study. Laparoscopic appendectomy is safe and feasible for the management of appendicitis without significant influence on the complications rate.

Laparoscopic versus open appendicectomy performed by adult general surgeons in pre-teenage years children: a single-centre experience.

The utilisation of laparoscopic appendicectomy (LA) in children remains contentious despite the well-recognised advantages of laparoscopic surgery. The purpose of this study was to compare intraoperative and postoperative outcomes in LA and open appendicectomy (OA) when performed by adult general surgeons outside specialist paediatric practice in younger children. A retrospective review of all patients under the age of 13 who underwent LA for suspected appendicitis over a two-year period was conducted. These were case-matched with an equivalent number of patients who underwent OA during the same period. Intraoperative and postoperative outcomes were compared. Fifty-one patients underwent LA during the study period. Patient demographics were statistically equivalent with the OA cohort. A statistically significant longer median operating time (58 vs 49min) was noted in the LA group, but intraoperative outcomes were otherwise comparable. LA, when compared with OA, was associated with a significant improvement in postoperative length of stay (2 vs 3 days, p < 0.001), postoperative complication rate (0% vs 6%, p = 0.01), negative appendicectomy rate (3.9% vs 17.6%, p < 0.001) and 30-day readmission rate (0% vs 5.9%, p = 0.03). No patients in the LA group required conversion to open surgery. LA can be safely delivered by adult general surgeons to younger paediatric populations outside the setting of paediatric specialist practice, with statistically significant improvements in postoperative outcomes noted when compared with OA. These findings are of importance in the current healthcare context where adult general surgeons continue to perform the majority of paediatric appendicectomies.

Modified endoscopic retrograde appendicitis therapy vs. laparoscopic appendectomy for uncomplicated acute appendicitis in children.

Modified endoscopic retrograde appendicitis therapy (mERAT) has been proposed as an alternative to laparoscopic appendectomy for the treatment of appendicitis. However, data from children in large samples are lacking. The aim of this article is to evaluate the efficacy between mERAT and laparoscopic appendectomy (LA) in children with uncomplicated appendicitis. We retrospectively analyzed 594 patients with suspected uncomplicated appendicitis from October 2018 to May 2021. A pool of 294 consecutive patients who met the inclusion criteria were ultimately enrolled in this study (228 and 66 patients in mERAT and LA, respectively). Given the differences in baseline clinical data (gender, age), the regression equation including differences in clinical baseline, grouping factor, and white blood cell count was established to address the influence of potential confounding factors. The initial success rate of mERAT management was 96.9%, and the recurrence rate was 6.9% in the mERAT group and 1.7% in the LA group within 1 year, which was no significant difference. But the mERAT group had a lower rate of adverse events. Finally, those results indicated that the treatment modalities, LA or mERAT, had no significant effect on initial success rate (P = 0.99) or recurrence rate (P = 0.17) within 1 year, but a significant effect on the adverse events rate during hospitalization (P = 0.01) in the multivariate regression analysis. Among children with uncomplicated appendicitis, an initial mERAT management strategy had a success rate of 96.9%, which was similar to the LA group at 1 year. This follow-up supports the feasibility of mERAT alone as an alternative to surgery for uncomplicated appendicitis.

Comparison of post operative pain between open and laparoscopic appendectomy in acute appendicitis.

Objective: To compare post-operative pain between open and laparoscopic appendectomy in patients diagnosed with appendicitis presenting at a tertiary care hospital, Karachi, Pakistan. Study Design: Observational study. Setting: Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan. Period: January 2023 to June 2023. Material &amp; Methods: The study included patients aged above 18 years of both genders, diagnosed with acute appendicitis based on ultrasound or CT scan. The decision regarding the surgical procedure was made by the surgeon team on call according to their experience and preference. Patients were divided into two groups, i.e., open appendectomy (OA) and laparoscopic appendectomy (LA). Pain in both groups was assessed at 12 hours and 24 hours after surgery using visual analogue scale. Results: The LA group had a mean age of 38.94±7.90 years, while the OA group had a mean age of 40.92±8.37 years. The mean BMI in the LA group was 36.75±8.50 kg/m2, and in the OA group, it was 37.56±6.22 kg/m2. When evaluating pain scores at the 12th (4.62±2.01 vs 5.28±1.91, p=0.027) and 24th hours (3.08±1.49 vs 3.64±1.61, p=0.017), the LA group exhibited lower pain scores compared to the OA group. Conclusion: As compared to OA, LA is superior approach in terms of post-operative pain in patients with acute appendicitis.

Post Appendicectomy Fistula: A Review of Its Management in 50 Cases

Introduction: Open appendectomy (OA) and laparoscopic appendectomy (LA) are the choices of treatment for acute appendicitis. However, laparoscopic approach is emerging for the benefits it provides, but it also sometimes may has some drawbacks like OA including fistula. Objective: This retrospective study aims to investigate the management of fistula in 50 post appendicectomy fistula patients. Methods: A retrospective study was done at MH Samorita Medical College &amp; Hospital, Hi-Tech Surgicare Hospital &amp; Piles Centre, Savar Specialized Hospital and Lab Zone Hospital Savar, Bangladesh during January 2019 to December 2023 from January 2019 to December 2023, among the patients who had underwent laparoscopic appendicectomy and open appendicectomy. The total study population was 50, among which 33 (66%) patients were in open appendectomy and 17 (34%) were in laparoscopic appendectomy. The patients’ age group included 10 years to 50 years of both male and female patients. P&lt; 0.005 was considered significant in this study. Results: Out of total study population, 33 were from OA (66%) and 17 were from LA (34%) group. Most of the study patients were male, aged 21-30 years age group. Fistulogram found to be the commonly use method to diagnose fistula. Tuberculosis was found to be the frequent cause of post appendicectomy fistula. Conclusion: Post appendicectomy seems to have different outcomes with some adverse impact, fistula is one of them. The present study finds that the chances of post appendicectomy fistula is less in LA group compared to OA. Proper study and better investigation may bring this to null with time.

Outcome of laparoscopic vs open appendectomy in the management of acute appendicitis

The worldwide trend of appendectomy is shifting from conventional open to the laparoscopic technique. The study’s objective was to compare laparoscopic and open appendectomy in terms of various operative and postoperative parameters to find the best operative technique. A prospective comparative study was conducted on 142 patients undergoing laparoscopic (n=43) or open appendectomy (n=99) from 1st February 2022 to 30th January 2023 under the Department of Surgery of Kathmandu Medical College Teaching Hospital (KMCTH). In five patients, laparoscopic appendectomy was later converted to open and excluded from the study. The mean operating time for the open appendectomy group was 44.1±13.1 minutes while for the laparoscopic appendectomy group, it was 48.4±14.0 minutes (p=0.047). Visual analogue score taken on 1st, 7th and 30th post-operative day for open and laparoscopic appendectomy were 4.0±2.2 vs 3.6±1.9 (p=0.160); 1.4±1.3 vs 0.6±0.9 (p&lt;0.001) and 0.2±0.5 vs 0.02±0.15 (p=0.107) respectively. The total days of postoperative hospital stay were 1.57±0.96 for open appendectomy and 1.58±1.07 for laparoscopic appendectomy (p=0.843). However, laparoscopic appendectomy group had an earlier return to normal activity (7.30±1.15 days) when compared to the open appendectomy group (8.05±2.42 days) (p=0.023). The laparoscopic appendectomy group also had fewer postoperative complications than the open appendectomy group (18.6% vs 24.2%) (p=0.411). Thus, laparoscopy is a safe and effective method of removal of appendix for acute appendicitis.

Comparison of outcomes of open and laparoscopic appendectomy: A retrospective cohort study.

Open appendectomy has been the conventional choice of treatment for acute appendicitis. However, nowadays laparoscopic approach is emerging for the benefits it provides, like lesser postoperative pain and lesser duration of hospital stay, but at the cost of higher expenses and longer operative duration. A retrospective cohort study was done at Shree Birendra Hospital from January 2018 to December 2021, with a total study population of 450 participants (300 in open appendectomy and 150 in laparoscopic appendectomy). Preoperative. Intraoperative and postoperative parameters were compared and analyzed between two groups using SPSS-25. The mean age was 26.72 ± 9.70 in the open appendectomy (OA) and years 23.89 ± 6.32 in the laparoscopic appendectomy (LA) group. (p = 0.010) There was a significant difference between the mean operative time (46.08 ± 13.10 min in OA and 56.86 ± 11.70 min in LA, p = 0.000), length of hospital stay (1.28 ± 0.80 days in OA and 1.07 ± 0.25 days in LA, p = 0.000), course of oral analgesics (3.55 ± 0.68 days in OA and 3.00 days in LA p = 0.000) between OA groups and LA groups, while the total number of complications was less in the LA group however there was no statistically significant difference postoperative complications (p = 0.124) between the two groups in the surgical findings. All in all, the laparoscopic approach is a better option for uncomplicated appendicitis due to its less postoperative pain and shorter duration of hospital stay.

Beyond the incisions: unraveling the superiority between laparoscopic versus open appendectomy

Background: Appendectomy is one of the most common surgical emergencies worldwide and is performed using either an open or a laparoscopic approach. Although minimally invasive surgeries are replacing open surgical procedures, laparoscopic appendectomy (LA) has not yet been established as the gold standard procedure compared to open appendectomy (OA). This study aimed to compare the outcomes of LA and OA in 100 cases and evaluate the feasibility, safety, and efficacy of LA as the preferred method for treating acute appendicitis. Methods: This study was a prospective comparative analysis of 100 patients with acute appendicitis who underwent LA or OA. This study was conducted at a tertiary care hospital (CMH Chattogram) between January 2021 and April 2023. Patients were divided into two groups: laparoscopic (n=50) and open (n=50) appendectomy. Both groups were compared for operative time, length of hospital stay, postoperative pain, complication rate, time to return to normal activity, and cosmetic outcome. Results: The mean operative time was significantly longer in the LA group (43 minutes) compared to the OA group (36.4 minutes) (p&lt;0.001). However, the LA group had significantly less postoperative pain with a mean VAS score of 2.04 at 48 hours postoperatively compared to 5.7 in the OA group(p&lt;0.001). LA group had a shorter length of hospital stay compared to the OA group (3.12 days versus 6.48 days, p&lt;0.001) and a faster time to return to normal activities (7.68 days versus 16.58 days, p&lt;0.001). the LA group had less surgical site infection compared to the open group, with 2 out of 50 compared to 8 in the open group (p&lt;0.46). The cosmetic outcome was measured with the scar scale where the LA group had a significantly better-looking scar with a score of 4.28 versus the score of 8.86 (p&lt;0.001) in the case of the OA group. Conclusions: While the longer operative time of LA was a drawback, its benefits in terms of the better visual field of vision during operation and improved patient outcomes make it the more favorable option for appendectomy.

Laparoscopic Appendectomy versus Open Appendectomy in Acute Appendicitis.

Appendectomy is the most common emergency surgical procedure performed. Appendectomy is performed by either open or laparoscopic methods. However, there is lack of consensus regarding the most appropriate method. This study aimed to compare the outcomes of laparoscopic and open appendectomy in the treatment of acute appendicitis. Fifty-two patients undergoing appendectomy were analyzed in this prospective comparative study, with 26 patients each in laparoscopic and open group. The outcomes were measured in terms of operative time, postoperative pain at 4, 6 and 12 hours, length of hospital stay, postoperative complications according to modified Clavien Dindo classification and cost analysis. Laparoscopic group had longer time after completion of surgery till exit from operation theatre (30 min in laparoscopic and 20 min in open, p<0.01) and significantly higher cost (Nrs. 26295 for laparoscopic and Nrs. 19575 for open, p<0.01) than open appendectomy. Operative time, time from entering operation theatre till being kept in operation table, time from being kept in operation table till initiation of anesthesia, postoperative pain at 4,6 and 12 hours and postoperative complications were insignificant in both groups. The results suggest that laparoscopic appendectomy group had longer recovery time after operation and was costlier than open appendectomy. Thus, the decision of the operative procedure can be based on the patient's preference.

Comparison between Open versus Laparoscopic Appendectomy

Objective: To compare the outcomes of laparoscopic appendectomy and open appendectomy for treatment of acute appendicitis. Study Design: Randomized control trial. Place and duration: Trial was conducted at department of general surgery Nishtar hospital Multan from November 2019 to November 2020 in one year duration. Methodology: Study was conducted on one hundred and fifty patients. Patients were divided into two groups, laparoscopic and open appendectomy groups. Hospital stay, duration of surgery and surgical site infection are the main variables. Results: The mean length of stay in hospital of laparoscopic appendectomy was slightly greater than the mean length of stay in hospital open appendectomy, (p=0.000). Rate of surgical site infections in open appendectomy was significantly higher than laparoscopic appendectomy, 34.7% and 18.7%, respectively p=0.027. Conclusion: Laparoscopic appendectomy is better than open appendectomy in terms surgical site infection, hospital stay and duration of surgery. Duration of surgery depends upon the skills of surgeon and team.

Outcomes of an enhanced recovery after surgery (ERAS) program to limit perioperative opioid use in outpatient minimally invasive GI and hernia surgeries.

Perioperative pain management is important for patient satisfaction while returning to homeostasis in the safest way possible. Studies show that patients don't require as much opioids as once thought. The benefits of ERAS pathways extend beyond enhancement of patients' perioperative experience, and include reducing opioid prescriptions in the face of the ongoing nationwide opioid crisis and evidence of prescription opioids as a contributor. We performed a retrospective cohort study of patients undergoing same day minimally invasive surgery (MIS) procedures for GI and hernia disease using a minimal-opioid ERAS protocol at two community hospitals between January 2020 and May 2022. We included elective laparoscopic cholecystectomy (LC), laparoscopic appendectomy (LA) for acute appendicitis without perforation, and minimally invasive (laparoscopic and robotic) inguinal and ventral hernia repair or abdominal wall reconstruction (AWR). Primary outcome was postoperative opioid use. A total of 509 patients were included, undergoing procedures of MIS hernia repair (52.5%), LC (43.6%), and LA (7.9%). Only 9.4% of patients received opioid prescriptions at discharge, with no difference between groups. Among the patients receiving a prescription at discharge, there was a significant difference in morphine milligram equivalents (MME) prescribed (25.0 ± 0.0 in the LA group, 65.0 ± 41.4 in the LC group, 100.6 ± 46.2 in the MIS hernia/AWR group; P = 0.015). Nine percent of patients called with pain management concerns postoperatively. ASA score ≥ 3 was associated with increased odds for postoperative opioid prescription (OR 2.084; P = 0.014). We demonstrate that an opioid-sparing ERAS program effectively manages pain for patients undergoing multiple outpatient MIS GI/hernia procedures, and suggests generalizability across a diverse range of operations. Therefore, the use of ERAS may safely and effectively expand beyond inpatient MIS and open surgeries that target reduced length of stay to also minimize opioids for outpatient procedures.

Single-center comparison of outcomes between laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy

PurposeAppendectomy is the most common pediatric emergency surgery performed to date. This study compared outcomes between laparoscopic appendectomy (LA) and transumbilical laparoscopic assisted appendectomy (TULAA) for 1154 uncomplicated patients across 5 years at a single institution. Primary outcomes include length of stay (LOS), post-operative complications, pain score, and operating room (OR) time. MethodsDemographic and clinical data was collected for 1154 eligible patients treated for uncomplicated appendicitis between August 2014–October 2019, with 830 patients in the LA group, and 324 in the TULAA group. Mixed effects modeling procedure using logistic and linear regression examined the effect of surgery type on the four primary outcomes after adjustment for potential clustering effect of surgeon and confounding factors. ResultsOf 1154 patients, 62.7% were male, and mean (SD) age was 10.9 (3.6) years. Median [IQR] LOS was 28.0 h [22.0, 36.0], mean (SD) OR time was 29.0 (10.0) minutes, and median [IQR] pain at maximum level was 5.5 (2.7). The complication rate overall was <5.0% and did not differ between TULAA and LA groups (p > 0.05). OR time was reduced by an average of 5.2 min in the TULAA group (p < 0.001), pain did not differ between groups overall (p > 0.05), and patients were more likely to be discharged within 24 h in patients who underwent TULAA (OR = 5.3 [1.6, 17.4], p = 0.007). ConclusionRetrospective analysis of 1154 pediatric appendectomies, found no difference in complications between single- and three-incision laparoscopic procedures (TULAA vs. LA). Findings suggest TULAA is a safe procedure for acute appendicitis in pediatrics. Level of EvidenceIV.

Perforated appendicitis treated with laparoscopic appendicectomy or open appendicectomy: A meta-analysis.

This analysis compared the impact of laparoscopic appendicectomy (LA) and open appendicectomy (OA) on treating adult perforated appendicitis (PA). Articles relating to LA and OA in treating PA were retrieved from databases including PubMed, Cochrane Library and Embase since their founding to January 2022. These articles were independently filtered based on the inclusion and exclusion criteria by two investigators. The quality of these articles was assessed and article data were extracted. Dichotomous data were presented in the form of odd's ratio (OR), whereas continuous data were in the form of weighted mean difference (WMD). The included articles reported at least one of the following outcomes: intra-abdominal abscess (IAA), wound infection, operative time, hospital stay and complications. Three randomised control trials (198 LA cases vs. 205 OA cases) and 12 case - control trials (914 LA cases vs. 2192 OA cases) were included. This analysis revealed that although the IAA formation rate was similar in the LA and OA groups (OR: 1.28, 95% confidence interval [CI]: 0.87-1.88), the wound infection rate was lower in the LA group (OR: 0.38, 95% CI: 0.28-0.51). Furthermore, LA was associated with shorter hospital stay (WMD: -1.43 days, 95% CI: -2.33--0.52) and fewer complications than OA (OR: 0.40, 95% CI: 0.28-0.57). LA has significant benefits in treating PA and is associated with better post-operative outcomes such as shorter hospital stay, lower incidence of wound infection and other complications. However, more studies with randomised and large-sample populations are still required to determine the clinical benefit of LA in treating PA.

Conservative antibiotic treatment of pediatric acute uncomplicated appendicitis during the COVID-19 pandemic: a prospective comparative cohort study

Our study aimed to compare the clinical outcomes and cost-efficiency of antibiotic management versus laparoscopic appendectomy for acute uncomplicated appendicitis (AUA) in children during the COVID-19 pandemic when resources were limited and transmission risks uncertain. In this prospective comparative cohort study, we analyzed the data of 139 children diagnosed with AUA meeting the following inclusion criteria: 5-18years of age, symptoms duration of ≤ 48h, appendix diameter ≤ 11mm and no appendicolith. Treatment outcomes between non-operative management group (78/139) and upfront laparoscopic appendectomy group (61/139) were compared. Antibiotic regimes were intravenous ceftriaxone/metronidazole or amoxicillin/clavulanic acid for 48h, followed by oral antibiotics to complete total 10-days course. 8/78 (10.3%) children had early failure (within 48h) requiring appendectomy. 17/70 (24.3%) patients experienced late recurrence within mean follow-up time of 16.2 ± 4.7months. There were no statistical differences in peri-operative complications, negative appendicectomy rate, and incidence of perforation and hospitalization duration between antibiotic and surgical treatment groups. Cost per patient in upfront surgical group was significantly higher ($6208.5 ± 5284.0) than antibiotic group ($3588.6 ± 3829.8; p = 0.001). Despite 24.3% risk of recurrence of appendicitis in 16.2 ± 4.7months, antibiotic therapy for AUA appears to be a safe and cost-effective alternative to upfront appendectomy.

A PROSPECTIVE COMPARATIVESTUDY OF OPEN VERSUS LAPAROSCOPIC APPENDECTOMY: A SINGLE UNIT STUDY

Introduction: Acute appendicitis is the most common general surgical emergency. Appendicectomy is the treatment of choice for acute appendicitis and the most commonly performed emergency abdominal operation. Open appendectomy is found safe and effective operation with low morbidity but found to be associated with post operative pain, wound infection and complications like intestinal obstruction which may delay recovery. Laparoscopic appendectomy emerged as a good option for treatment of appendicitis. The purpose of this study was to compare the laparoscopic versus open approach among patients with appendicitis in our centre. Materials And Methods: This study was a prospective study of 100 patients with clinically diagnosed as appendicitis admitted in the department of General Surgery, Unit II, Zoram Medical College for a period of two years during November 2019 to October 2021. They were divided into two groups - Open Appendectomy (OA) group and Laparoscopic Appendectomy (LA) group of 50 patients each. Age ranges from 10yrs to 75yrs. Exclusion criteria were pregnant female, chronic medical problems, haemodynamically unstable or psychiatric illness, cirrhosis, coagulation disorders, patients on steroid, immuno-compromised patients, patients on chemotherapy for malignancy and those who are not willing to participate. OA was performed through standard Mc Burney incision. LA was performed through a standard 3 ports technique. Results: The most common presentation of appendicitis is abdominal pain followed by nausea/vomiting and common in younger age group of 10-20 years. Laparoscopic Appendectomy was found as safe and effective as Open Appendectomy. LA has more acceptable cosmetic result, shorter hospital stay and less postoperative pain. The pain score was significantly reduced in LA group (3.2+-1.4) and in OA (4.1+-1.8). Conclusion: LA was found as safe and effective as OA. LA has more acceptable cosmetic result, shorter hospital stay and less postoperative pain.

AbcApp: incidence of intra-abdominal ABsCesses following laparoscopic vs. open APPendectomy in complicated appendicitis

BackgroundPatients with complicated appendicitis are more at risk for the occurrence of postoperative intra-abdominal abscesses than patients with uncomplicated appendicitis. Studies comparing laparoscopic and open appendectomy showed limitations and contradictory findings on the incidence of intra-abdominal abscesses after appendicitis, as most of these studies analysed both uncomplicated and complicated appendicitis as one group. The aim of the present study is to investigate the incidence of intra-abdominal abscesses after laparoscopic versus open appendectomy for complicated appendicitis.MethodsA retrospective cohort study was performed over the period January 2009 till May 2020. All patients who had an intra-operative diagnosis of complicated appendicitis (e.g. perforation, necrosis) were included. The outcome measure was the occurrence of intra-abdominal abscesses with a postoperative follow-up of 30 days. Multivariate logistic regression analysis was performed including adjustments for significant confounders.ResultsA total of 900 patients had undergone appendectomy for complicated appendicitis. The majority was operated laparoscopically (78%, n = 705). The incidence of postoperative intra-abdominal abscess was 12.3% in both laparoscopic and open appendectomy groups. On univariable analysis, the postoperative rates of intra-abdominal abscesses between laparoscopic and open appendectomy were not significantly different (odds ratio 1.11, 95% CI [0.67–1.84], p = 0.681).ConclusionThe present study provides evidence that, in current daily practice, intra-abdominal abscess formation remains a common postoperative complication for complicated appendicitis. Nonetheless, no significant difference was found with regard to intra-abdominal abscess formation when comparing laparoscopy with open surgery.

Comparison of Laparoscopic Appendectomy with Open Appendectomy with Respect to Surgical Site Infection

Aim: The purpose of this study is to compare the incidence of wound infection in laparoscopic and open appendectomy. Study Design: A randomized, controlled study Place and Duration: In the Surgical department of Khalifa Gul Nawaz Medical Teaching Institute, Bannu and Ayub Teaching Hospital, Abbottabad for the duration from January 2021 to June 2021. Methods: In this study, 220 patients with the diagnosis of acute appendicitis were selected and divided randomly into two groups; OA group (open appendectomy) and LA group (laparoscopic) appendectomy. In both groups, the general anesthesia was given for appendectomy. The wound was examined on the 1st, 2nd and 3rd postoperative day, and then on the 7th and 14th day postoperatively and was scored conferring to the wound asepsis Score. The SSI and total wound asepsis score was calculated subsequently. Results: Total of 200 patients with acute appendicitis were selected. In laparoscopic appendectomy (LA); 22.0±7.85 years was the mean age and 24.12±9.08 years was the mean age in open appendectomy (OA) group. There were 70 men and 40 women in the LA group, and 50 men and 60 women in the OA group. The LA group has M:F ratio of 1.9: 1 in the and 1: 1.3 in the OA group. While 108 patients had no complications and surgical site infection were noticed in two patients only in the LA group, 98 patients in the OA group recovered and surgical site infection were seen in 12 patients. Conclusion: Laparoscopic appendectomy is a safer and better choice than open appendectomy which decreases postoperative complications significantly such as wound infections. Keywords: Open appendectomy, Laparoscopic appendectomy, Acute appendicitis and Surgical site infection.

Outcome and quality of life in obese patients underwent laparoscopic vs. open appendectomy

BackgroundAlthough obesity is a popular reason for choosing laparoscopic appendectomy (LA) versus open appendectomy (OA), however, the question of whether there is a difference remains. Our goal is to investigate if there is a difference between OA and LA in obese patients.MethodsFifty-eight obese patients diagnosed with acute appendicitis according to ALVARDO score at department of surgery at Suez Canal university hospitals from March 2020 till August 2021 were included. The study participants were assigned in two groups LA and OA. This study aimed to comparing between LA and OA regarding intraoperative complications, length of hospital stays, post -operative pain, and rate of post-operative complications. Meanwhile, using SF-36 scoring questionnaire, the quality of life was compared between both groups.ResultsA total of 58 patients were included in the present study (LG = 29 patients and OG = 29 patients). The early post-operative complications (within 30 days after surgery) were significantly lower in the LA group (5 patients out of 29) than the OA (11 patients out of 29). Additionally, lower incidence of complications was noticed in the LA group (2 out of 29 patients) compared to OA (6 patients out of 29) beyond 30 days after operation. Patients with laparoscopic surgery had statistically significant higher overall quality of life scores (SF-36) (72 ± 32) compared to open surgery patients (66 ± 35) 2 weeks after operation.ConclusionThe laparoscopic procedure was associated with lower incidence of post operative complications. However, open appendectomy was superior for a shorter operative time. Laparoscopic approach is not only used for therapeutic purposes, but also it has a diagnostic role.

Laparoscopic versus Open Appendectomy: A Prospective Comparative Study and 4-Year Experience in a Tertiary Care Hospital.

Background The aim of this study was to validate the pros of laparoscopic appendectomy (LA) over open appendectomy (OA) and to compare various primary outcome measures in the management of acute and recurrent appendicitis. Study Design Prospective comparative study. Place and Duration Between June 2015 and October 2019 in JJ Hospital, Mumbai. Materials and Methods Total of 60 patients with acute and recurrent appendicitis were included in the study. Thirty patients underwent OA and 30 underwent LA. Both groups were comparable clinicopathologically and demographically. Various intraoperative and postoperative parameters were compared. Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as percentages. Mann–Whitney U test was used to compare continuous variables and chi-squared test was used to compare categorical variables. p -Value≤0.001 was considered to be statistically significant. Results The median age of patients undergoing OA and LA was 24.9 and 25.2 years ( p = 0.221), respectively. Female: male ratio in OA and LA was 1.30 and 1.14, respectively ( p = 0.795). Mean operative duration in LA and OA group was 47.17 ± 14.39 minutes and 36.9 ± 12.33 minutes ( p = 0.001), respectively. Mean length of postoperative stay in LA and OA group was 3.69 ± 0.71 days and 5.28 ± 0.63 days ( p = 0.000), respectively. Median visual analogue scale score in LA and OA group was 3.5 and 5 ( p = 0.001), respectively. Mean time to return to normal activity in LA and OA group was 8.13 ± 1.33 days and 10.10 ± 2.20 days ( p = 0.000), respectively. About 6.66% patients in LA group and 13.33% in OA group had postoperative wound infection ( p = 0.652). Mean scar scale scoring done on 30th postoperative day was 4.23 in LA and 8.23 in OA ( p = 0.000). Discussion and Conclusion LA is more promising than OA in the management of acute and recurrent appendicitis. LA offers lesser operative site pain in the postoperative period, shorter postoperative hospital stays, earlier recovery, and return to normal activities and cosmetically better scars on 30th day follow-up. No conversions or significant difference in wound related complications were seen in both groups. Prolonged intraoperative duration was the only drawback of LA.

Laparoscopic versus open appendectomy in patients with acute appendicitis

Background and aim There were numerous previous studies comparing open appendectomy (OA) with laparoscopic appendectomy (LA). Although most of these have concluded that the LA is good as OA, there has been considerable controversy as to whether LA is superior to OA or not. The goal of this study was to compare the results of the previous two surgical methods and determine if LA is better than OA. Patients and methods A prospective research, including 40 patients with a suspected acute appendicitis, was conducted between January 2018 and May 2019. The LA group had 20 patients, while the OA group had 20 cases. LA was performed using three trocars/cannulas to create pneumoperitoneum with CO2, whereas OA was done using the Mc Burney incision (Clinical trial registration number : PACTR202203884835048). Results Appendectomies were done on 14 males and 26 women for a total of 40 appendectomies. In LA, the mean operative time was 45.50±13.26 min, whereas in OA, it was 53.50±14.78 min (P=0.001). In the LA group, none of the patients experienced intraoperative problems, but four individuals in the OA group did. Postoperative problems were observed in four (20%) patients in the LA group and five (25%) patients in the OA group. Compared with those who had OA, those who had LA had a considerably shorter hospital stay (14.60±5.45 vs. 24.10±5.60 h, P=0.001). Conclusions LA is just as safe and successful as OA, with key advantages such as less discomfort, fewer wound infections, and shorter hospital stays.