Comparison of Outcomes of Laparoscopic and Open Appendectomy in Management of Appendicitis

Abstract

Objective: To compare the outcomes in relations to postoperative pain and complications, and hospital stay of laparoscopic versus open appendectomy in management of appendicitis. Study Design: Cross sectional study. Place and Duration of Study:    This study was conducted in department of surgery Unit III of PUMHS Nawabshah and Suleman Roshan Medical College Tando Adam, Sindh Pakistan, from January 2020 to December 2021. Methodology: This study consisted of 136 consecutive cases of either gender, aged between 13 to 60 years, that were enrolled during study period and matching with the inclusion and exclusion criteria. After the permission of ethical committee, a detailed history was taken from all the patients with special regard to the pain in RIF, Pain starting around umbilicus, nausea, vomiting, fever and altered bowel habits. All the cases were randomly divided into  Group A comprising of 68 cases which were operated by conventional open appendectomy (OA) and other group B also comprising of 68 cases which were operated by laparoscopically appendectomy (LA). All the clinical and demographic data was collected on a proforma designed for the study, and analyzed by using Statistical Package for Social Science (SPSS) software version 22. Effect modifier like age, gender was controlled by stratification and chi-square test was applied to see the effect of these on both open versus laparoscopic appendectomy outcome variable. P <0.05 was taken as significant. Results: In open appendectomy group male:female ratio of 1.2:1 and in laparoscopically appendectomy group male:female ratio of 1.5:1. The mean age was 31.28±4.30 years for OA group and 35.47±3.23 years for LA group (p 0.02).Alvarado score was showed <4 Score 0% in both groups, where as 4-7 Score in 9(13.23%) patients of OA group and 8(11.76%) patients of LA group, and > 7 Score was seen in 59(86.76%) patients of OA group and 60(83.23%) patients of LA group.  The mean time in OA group was 45.21±12.1 minutes and LA group was 43.44±9.4 minutes (p 0.026).Mild pain was felt in 7(10.29%) patients of OA group and 39(57.35%) patients of LA group, Moderate pain was seen in 31(45.58%) patients of OA group and 26(38.23%) patients of LA group, severe pain was described by 30 (44.11%) patients in OA group and 3(4.41%) patients in LA group (p 0.005).The common complications seen in this study Ileus was 29(42.64%) patients in OA and 18(26.47%) patients in LA group) followed by wound infection 10(14.70%) patients in OA and 1(1.47%) patients in LA group. The duration of hospital stay was longer about 3-4 days in 58(85.29%) of OA patients as compared to LA cases where majority 65(95.58%) were discharged within 2 to 3 days.    Conclusion: We conclude that laparoscopic appendectomy procedure has a low rate of complications, earlier mobilization, implies a shorter hospital stay and offers the patient a more comfortable postoperative period than open appendectomy procedure.