RESEARCH ARTICLE | https://doi.org/10.5005/jp-journals-10033-1468 |
A Comparative Study between Open Appendicectomy and Laparoscopic Appendicectomy: A Single-center Experience
1–3Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India
Corresponding Author: Vikram Yogish, Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, Phone: +91 9843616909, e-mail: yogishvikram@gmail.com
How to cite this article: Yogish V, Grover H, Bharath V. A Comparative Study between Open Appendicectomy and Laparoscopic Appendicectomy: A Single-center Experience. World J Lap Surg 2021;14(3):205–207.
Source of support: Nil
Conflict of interest: None
ABSTRACT
Appendicitis is a surgical emergency that is encountered by surgeons all over the world. Today, laparoscopic appendicectomy is the ideal procedure that is done for a case of appendicitis.
Aim: The aim of the study is to show the benefits of laparoscopic appendicectomy and to determine the advantages of laparoscopic appendicectomy over the conventional open method of appendicectomy.
Materials and methods: This was a prospective study that was carried out from March 2016 to February 2019. The study was conducted at SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India. Investigations, such as complete blood count (CBC), X-ray of the abdomen, ultrasound abdomen, and CT scan of the abdomen, were done. A total of 101 patients were studied, and the results obtained were tabulated. The statistics were analyzed using SPSS package 16.0. Ethical clearance was obtained from the institutional ethics committee.
Results: From our study, it was found that for most of the patients who presented with appendicitis, laparoscopic appendicectomy was the procedure of choice (66.33%). The duration of surgery for most of our patients was 60 minutes or less. Moreover, 82.35% of patients who underwent open appendicectomy and 89.55% of patients who underwent laparoscopic appendicectomy stayed in the hospital for only 3 days or less after surgery.
Conclusion: Our study shows the benefits of laparoscopic appendicectomy and the reason that it is the procedure of choice in cases of appendicitis.
Keywords: Appendicitis, Laparoscopic appendicectomy, Open appendicectomy, Ultrasound abdomen.
INTRODUCTION
Appendicitis is a surgical emergency that is encountered by surgeons all over the world. In order to diagnose a condition of appendicitis accurately, a detailed history and a thorough clinical examination must be done. Investigations, such as complete blood count (CBC), ultrasound abdomen, and CT scan of the abdomen, are very useful that may be done to arrive at the diagnosis of appendicitis. As far as the intervention for a case of appendicitis is concerned, surgery may be done either through open or laparoscopic method. Today, laparoscopic appendicectomy is the ideal procedure that is done for a case of appendicitis. However, it is also important to know when to convert a case of laparoscopic appendicectomy to open appendicectomy.
AIM
The aim of the study is to show the benefits of laparoscopic appendicectomy and to determine the advantages of laparoscopic appendicectomy over the conventional open method of appendicectomy.
MATERIALS AND METHODS
This was a prospective study that was carried out from March 2016 to February 2019, for a period of 3 years. The study was conducted at SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India. A detailed history was collected and a thorough clinical examination was done. Investigations, such as CBC, X-ray of the abdomen, ultrasound abdomen, and CT scan of the abdomen, were done. The CT scan of the abdomen was done only when absolutely required. A total of 101 patients were studied, and the results obtained were tabulated. The statistics were analyzed using SPSS package 16.0. Ethical clearance was obtained from the institutional ethics committee.
RESULTS
From the results of our study, it was found that for most of the patients who presented with appendicitis, laparoscopic appendicectomy was the procedure of choice (66.33%). The patients usually presented to the hospital with complaints of abdominal pain over the right lower quadrant. The hospital stay for most of our patients was 3 days or less. Moreover, 82.35% of patients who underwent open appendicectomy and 89.55% of patients who underwent laparoscopic appendicectomy stayed in the hospital for only 3 days or less after surgery. The duration of surgery for most of our patients was 60 minutes or less. It was also seen that the patients who underwent laparoscopic appendicectomy were able to return to work faster than those who had to undergo the conventional open method of appendicectomy (Tables 1 to 6).
| Age (years) | Open appendicectomy (n = 34) | Percentage | Laparoscopic appendicectomy (n = 67) | Percentage |
|---|---|---|---|---|
| 20–30 | 7 | 20.58 | 31 | 46.26 |
| 31–40 | 10 | 29.41 | 15 | 22.38 |
| 41–50 | 5 | 14.70 | 10 | 14.92 |
| 51–60 | 8 | 23.52 | 4 | 5.97 |
| 61–70 | 4 | 11.76 | 7 | 10.44 |
| Gender | Open appendicectomy (n = 34) | Percentage | Laparoscopic appendicectomy (n = 67) | Percentage |
|---|---|---|---|---|
| Male | 20 | 58.82 | 40 | 59.70 |
| Female | 14 | 41.17 | 27 | 40.29 |
| Presentation | No. of patients | Percentage |
|---|---|---|
| Abdominal pain over the right lower quadrant | 72 | 71.28 |
| Nausea | 20 | 19.80 |
| Vomiting | 25 | 24.75 |
| Fever | 45 | 44.55 |
| Duration of hospital stay after surgery (days) | Open appendicectomy (n = 34) | Percentage | Laparoscopic appendicectomy (n = 67) | Percentage |
|---|---|---|---|---|
| 3 days or less | 28 | 82.35 | 60 | 89.55 |
| 4–7 days | 4 | 11.76 | 5 | 7.46 |
| 8–15 days | 2 | 5.88 | 2 | 2.98 |
| Duration of surgery (minutes) | Open appendicectomy (n = 34) | Percentage | Laparoscopic appendicectomy (n = 67) | Percentage |
|---|---|---|---|---|
| 60 minutes or less | 20 | 58.82 | 37 | 55.22 |
| 61–90 minutes | 10 | 29.41 | 23 | 34.32 |
| 91–120 minutes | 4 | 11.76 | 7 | 10.44 |
| Return to routine work (days) | Open appendicectomy (n = 34) | Percentage | Laparoscopic appendicectomy (n = 67) | Percentage |
|---|---|---|---|---|
| 7 days or less | 15 | 44.11 | 45 | 67.16 |
| 8–14 days | 10 | 29.41 | 15 | 22.38 |
| More than 15 days | 9 | 26.47 | 7 | 10.44 |
DISCUSSION
Today, laparoscopic appendicectomy is considered a safe and effective method to treat appendicitis. When a patient is admitted in the hospital with appendicitis, initially antibiotics must be started and then a decision must be taken on the need for appendicectomy. A large series of laparoscopic appendicectomy for acute appendicitis initially came from Germany and was published by Pier et al.1 Laparoscopic appendicectomy has several advantages over the conventional open method of appendicectomy. In the laparoscopic method, the patient’s recovery is quicker, and the patient can also return to his or her routine work at the earliest. The amount of pain that the patient may endure is far less in the laparoscopic method than in the open method. Ortega et al., in their study of 135 patients, showed that the pain level was much less in the laparoscopic method as compared to the open method.2 The problem of wound infection is also much less in the laparoscopic method. Marzouk et al. also showed in his study that the postoperative wound infection rate was much less in the laparoscopic method.3 The length of hospital stay is significantly reduced if a laparoscopic appendicectomy is done as compared to the open method. In their studies, Ray-Offor et al.,4 Rbihat et al.,5 and Vellani et al.,6 showed that the length of hospital stay was much shorter for the patients who underwent laparoscopic appendicectomy. In our study, the patients who underwent laparoscopic appendicectomy had a hospital stay of 3 days or less after surgery. The operative time is also reduced quite a bit in case of laparoscopic appendicectomy. Our study also shows that most of our patients had an operative time of 60 minutes or less. The need for analgesia reduces significantly in the case of laparoscopic appendicectomy. Biondi et al., in their study of 593 patients, showed that laparoscopic appendicectomy was associated with a shorter hospital stay, with a less need for analgesia and with a faster return to daily activities.7 Shaikh et al. also showed in their study the need for lesser requirement of analgesia following laparoscopic appendicectomy.8 Li et al. also reported similar findings in their meta-analysis.9 In the case of young women, further care is needed while making a diagnosis of appendicitis since the differential diagnosis of right lower quadrant pain is extensive and includes gynecologic pathology as well.10 In addition, Azaro et al. had previously conducted studies to show that laparoscopic appendicectomy is a safe procedure.11 The port placement and the sites of the incisions are extremely important while performing laparoscopic appendicectomy. Studies have been done to improve cosmesis in cases of laparoscopic appendicectomy (Tables 7 and 8).12
| Presentation | Our study | Rangarajan et al.13 | Yakan et al.14 |
|---|---|---|---|
| Abdominal pain over the right lower quadrant | 71.28% | 66.67% | 89% |
| Procedure | Our study | Yau et al.15 |
|---|---|---|
| Open appendicectomy | 33.66% | 28.27% |
| Laparoscopic appendicectomy | 66.33% | 71.72% |
CONCLUSION
From our study, it was found that laparoscopic appendicectomy (66.33%) was the preferred choice of surgery for appendicitis. The hospital stay was 3 days or less for most of our patients. Moreover, 82.35% of patients who underwent open appendicectomy and 89.55% of patients who underwent laparoscopic appendicectomy stayed in the hospital for only 3 days or less after surgery. The duration of surgery was 60 minutes or less in 58.82% of patients who underwent open appendicectomy and in 55.22% of patients who underwent laparoscopic appendicectomy. The patients who underwent laparoscopic appendicectomy were able to return to work faster (67.16%) than those who underwent open appendicectomy. This shows that laparoscopic appendicectomy has a clear advantage over open appendicectomy and the reason that laparoscopic appendicectomy is the procedure of choice in cases of appendicitis.
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