Prakash, Bhoma Anand
(2006)
A prospective randomized comparative study of laparoscopic appendicectomy versus open appendicestomy in Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background: Since the demonstration of laparoscopic appendicectomy by K. Semm in
1983, it is performed worldwide though criticized by many. Open appendicectomy is a
brief procedure but is definitely associated with morbidity and can cause difficulty in
uncertain diagnosis. Laparoscopic appendicectomy has been a standard surgical
procedure performed in Hospital Universiti Sains Malaysia, but a prospective
randomized study comparing various parameters in between LA and OA has not been
done before.
Objectives: To compare various surgical times, complications and outcomes in between
LA and OA in HUSM.
Design: Prospective randomized comparative study.
Results: This study was conducted in Hospital Universiti Sains Malaysia from February
2006 till November 2006. Total of 97 patients were randomized in the study. Amongst
them, 53 patients underwent open appendicectomy (OA) and 44 patients underwent
laparoscopic appendicectomy (LA). In the study, 54.6% patients were males and 45.4%
were females (P = 0.2). The median age in LA and OA groups was 18 and 20 years
respectively. The mean Body Mass Index (BMI) in both groups was same. (22kglm2)
Patients in LA group had to wait longer for appendicectomy compared with OA groupand it was 22.2 hours versus 15.8 hours (P = 0.04). The operating time for laparoscopic
appendicectomy group as well as for open appendicectomy group was similar (70.2
minutes). Patients in LA group tolerated normal diet significantly earlier (36.6 hours
versus 55.4 hours, P = 0.05) and were discharged earlier compared to OA group (2.4
days versus 3.6 days, P=0.2). Eight patients in the laparoscopic group were converted to
OA, intra-operatively (18.1 %). Acute appendicitis was the commonest intra-operative
finding (72.2%) followed by perforated appendicitis (20.6%). Wound infection rate in
OA group was 7.5% compared to 2.8% in LA group. The overall negative
appendicectomy rate was 3.1% in the study.
Conclusion: The results of this prospective randomized comparative study disapproves
the concept that laparoscopic appendicectomy is a prolonged procedure, when
compared to open appendicectomy. So the perception that laparoscopic appendicectomy
is a prolonged procedure should be avoided. There is early return of bowel function,
shorter post operative hospital stay, less pain and lower wound infection rate after
laparoscopic appendicectomy when compared to open appendicectomy. Perforated and
gangrenous appendicitis can also be handled by laparoscopic appendicectomy safely
and are not the contraindications for laparoscopic appendicectomy. Diagnostic
laparoscopy should be considered among females in reproductive age group with
uncertain diagnosis.
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