Original Research Article
Year: 2017 | Month: February | Volume: 7 | Issue: 2 | Pages: 24-30
Laparoscopic Versus Open Appendicectomy: A Clinical Observation
Dr Purujit Choudhury
Associate Professor of Surgery, Gauhati Medical College, Assam, India.
ABSTRACT
Background: Acute appendicitis is a common indication for abdominal surgery with a life time incidence between 7-9% and appendicectomy is one of the most common surgical procedures. Open appendicectomy (OA) performed through the right lower quadrant incision was first described in 1894. It has become the standard treatment of choice for acute appendicitis, remaining mainly unchanged for 100 years due to its favorable efficacy and safety. Laparoscopic appendicectomy (LA), first performed by Semm in 1983, has gradually gained acceptance. However, there remains a continuining controversy in the literature regarding the most appropriate method of removing the inflamed appendix.
Methods: In a hospital based single center observation on laparoscopic versusopen appendicectomy, 224 out of 355 consecutive patients consented to participate. 132 patients were allocated for open procedure and remaining 92 patients under went laparoscopic procedure.18 patients out of 92 needed to be converted to open appendicectomy.131 patients did not participated. Length of stay in hospital was the primary consideration, while operating time, postoperative morbidity, duration of convalescence and cosmesis were secondary consideration.
Results: Intention-to-treat analysis revealed an equally short hospital stay in the two groups (average median 2 days though most patients could discharge after 1 day in laparoscopic group). The median time to return to normal activity (7 versus 10 days) and work (10 versus 16 days) was significantly shorter following laparoscopy. Laparoscopy was associated with fewer wound infections and improved cosmesis but the operating time was longer (60 versus40min). Laparoscopy was associated with more intraperitoneal abscesses (5 versus 1 per cent) but, adjusted for a greater number of gangrenous or perforated appendices in this group, the difference failed to reach statistical significance.
Conclusion: Though hospital stay was equally short in open and laparoscopic most patients could go home on 2nd post-operative day after laparoscopic appendicectomy. Laparoscopic appendicectomy was associated with fewer wound infections, faster recovery, earlier return to work, less post operative pain and improved cosmesis though slight and negligible higher intra-abdominal abscess.
Key words: Laparoscopic appendicectomy; Cosmesis; Converted.