JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

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2020 Month : May Volume : 7 Issue : 20 Page : 996-1000.

A Comparative Clinical Study of Therapeutic Effects and Safety of Laparoscopic and Conventional Open Appendectomy.

Boda Kumaraswamy1, A. Sanjeev Kumar2

Corresponding Author:
Dr. A, Sanjeev Kumar,
Assistant Professor,
Department of General Surgery,
Government Medical College and Government General Hospital,
Nizamabad, Telangana.
E-mail: drsanjeev57327@gmail.com

ABSTRACT
BACKGROUND
Acute appendicitis is a common disease seen by practicing surgeons in India. The prevalence in India is between 7.4 to 9.2%. Appendicectomy is a very common surgical procedure performed in hospitals. It affects all age groups. Open appendectomy (OA) is being replaced by laparoscopic appendicectomy (LA) nowadays in India. However, there are few controversies in the literature regarding the most appropriate method of removing the inflamed appendix.

METHODS
68 Patients admitted in the Department of General Surgery with Acute Appendicitis were randomly allotted to Open Appendicectomy group (OA group- 34) and Laparoscopic Appendicectomy group (LA group- 34). All patients were investigated with fixed surgical profile including, hematological, respiratory, cardiovascular and kidney function tests. A random number obtained from online random.org was used to allot the patients to either of the groups of LA and OA. All the surgeries were performed by the same surgeon and anaesthetist team. All patients had a BMI less than 25 Kg/m2 to 35 Kg/m2.

RESULTS
Out of 68 patients, 45 (66.17%) were males and 23 (33.82%) females with a male to female ratio of 1.95:1. The mean age was 24.15 ± 2.55 years. In group LA there were 21 (61.76%) males and 13/34 (38.23%) were females with a male to female ratio of 1.61:1. In group OA there were 23/34 (67.64%) males and 11/34 (32.35%) females with a male to female ratio of 2.09:1. The mean basal metabolic rate in group LA was 31.50 Kg/m2 and in group OA was 31.70 Kg/m2. It was observed from this study that the parameters of operative and post-operative recovery period in terms of operation time, mean hospital stay, mean resumption of time of normal activities, mean resumption of time of normal diet and VAS score for postoperative pain were statistically significant (p taken as significant at <0.05).

CONCLUSIONS
Operating time, postoperative length of hospital stay, resumption time of normal activities and diet, and postoperative pain (assessed by visual analogue scale (VAS) graded from 0 to 10, with 0 being no pain and 10 being the most intense pain) were favourable with laparoscopic surgery than with open appendicectomy. Complications such as postoperative ileus, intraoperative bleeding (>500 mL), urinary tract infection (UTI) and intra-abdominal abscess (IAA) formation following LA vs. OA techniques were not significant except wound infection which was significantly low with LA group.

KEYWORDS
Acute Appendicitis, Laparoscopy, Open Abdominal Surgery, Complications and Hospital Stay