31.8.27 Compare the Outcomes of Laparoscopic Appendectomy Versus Conventional Open Appendectomy

Original Article

 

Laparoscopic Appendectomy VS Conventional Open Appendectomy

Compare the Outcomes of Laparoscopic Appendectomy Versus Conventional Open Appendectomy

Barka Sajjad1, Shoaib Muhammad1, Tahirullah1 and Imran-ud-Din Khan2

ABSTRACT

Objective: To examine the outcomes of laparoscopic appendectomy and compare with conventional appendectomy.

Study design: Retrospective study

Place and Duration of Study: This study was conducted at the Department of Surgery, Muhammad Teaching Hospital Peshawar from October 2019 to May 2020.

Materials and Methods: One hundred and sixty patients of both genders with ages 15 to 50 years presented with acute appendicitis were enrolled. Patient’s detailed demographics were recorded after written consent. All the patients categorized in to two equal groups. Group 1 consist of 80 patients and received laparoscopic procedure, group 2 with 80 patients received open procedure. Outcomes such as time duration of surgery, hospital stay, need for analgesic, wound infection, return to routine activities and patients satisfaction were compare between both groups.

Results: No significant difference was observed regarding age, sex and BMI between both groups (p-value>0.05). Open appendectomy had significantly shorter operative time than laparoscopic appendectomy 32.51±8.45 minutes Vs 46.35±8.22 minutes (p-value <0.05). Laparoscopic appendectomy had significantly shorter hospital stay, less need for analgesic doses/day, less wound infection rate, and shorter time to return to routine activities as compared to open appendectomy with p-value <0.05. No significant difference was observed regarding patients satisfaction between both groups.

Conclusion: Laparoscopic appendectomy is safe and effective procedure for acute appendicitis as compared to open appendectomy

Key Words: Outcome, Laparoscopic appendectomy, Conventional open appendectomy

Citation of article: Sajjad B, Muhammad S, Tahirullah, Khan ID. Compare the Outcomes of Laparoscopic Appendectomy Versus Conventional Open Appendectomy. Med Forum 2020;31(8):114-117.

 

 

INTRODUCTION

The most common cause of surgical abdomen in all age groups is appendicitis.1,2 The average prevalence of acute appendicitis in the latter and third decades of life is about 7–10% of the total populations.3 Open appendectomy has been the standard for the diagnosis of patients suffering from acute appendicitis for a 100-year period, but today there is a lot of debate on the consequences and superiority of laparoscopy in comparison to open procedure.4 It has been demonstrated that limited surgical damage by laparoscopy resulted in a significant reduction of hospital residency, reduced postoperative discomfort,

 

 

1. Department of Surgery, Muhammad Teaching Hospital Peshawar.

2. Department of Surgery, Khyber Teaching Hospital, Peshawar.

 

 

Correspondence: Dr. Imran-ud-Din Khan, Senior Registrar Department of Surgery Khyber Teaching Hospital, Peshawar.

Contact No: 0335-5951691

Email: Ikmarwat47@gmail.com

 

 

Received:    June, 2020

Accepted:    July, 2020

Printed:        August, 2020

 

 

 

 

and an increased return to daily activity in several gastrointestinal surgery settings.5 Many observational trials, however, have provided contrasting findings, including randomized experiments and meta-analyses6-8 comparing laparoscopic and open appendectomy. Many of the trials indicated improved laparoscopic results, whereas other tests have shown minimal or non-clinical benefit and increased running cost.9-11 With this research aimed to assess every potential benefit of this laparoscopic technique, in the light of the fact that laparoscopic appendectomy has not been considered superior of open surgery for acute appendicitis.12 The present study was conducted aimed to examine the outcomes laparoscopic appendectomy and compare with open appendectomy.

MATERIALS AND METHODS

This retrospective/observational study was conducted at Muhammad Teaching Hospital Peshawar from 1st October 2019 to 31st May 2020. A total of 160 patients of both genders with ages 15 to 50 years presented with acute appendicitis were included. Patients demographic including age, sex and BMI were recorded after written consent. Complete blood picture was examined. Pregnant women, patients with history of abdominal surgery, patients with recurrence and those with no consent were excluded. All the patients categorized in to two equal groups. Group 1 consist of 80 patients and received laparoscopic procedure, group 2 with 80 patients received open procedure. Postoperative outcomes such as time duration of surgery, hospital stay, need for analgesic, wound infection, return to routine activities and patients satisfaction were compare between both groups. All the data was analyzed SPSS 24. Chi-square test was applied to compare the outcomes between both groups with p-value <0.05 was taken as significant.

RESULTS

In group 1, 48 (60%) were male and 32 (40%) were females with mean age 26.36±6.48 years and in group 2, 43 (53.75%) were male and 37 (46.25%) were females with mean age 25.93±6.23 years. Mean BMI in group 1 and 2 were 23.02±2.45 kg/m2 and 22.86±2.64 kg/m2. No significant difference was observed regarding age, gender and BMI between both groups with p-value >0.05 (Table 1). According to the operative finding, 135 (84.38%) patients (70 in group 1, 65 in group 2) had inflammative appendicitis, 15 (9.38%) patients (7 in group 1 and 8 in group 2) had perforated and 10 (6.25%) patients (5 in group 1 and 5 in group 2) had gangrenous appendicitis (Table 2). According to the postoperative outcomes, open appendectomy had significantly shorter operative time than laparoscopic appendectomy 32.51±8.45 minutes vs 46.35±8.22 minutes (p-value <0.05). However, Laparoscopic appendectomy had significantly shorter hospital stay, less need for analgesic doses/day, less wound infection rate, and shorter time to return to routine activities as compared to open appendectomy with p-value <0.05 (Table 3). No significant difference was observed regarding patients satisfaction between both groups. All the patients of both groups were satisfied with the procedure. None of the patient in both groups reported non-satisfaction.

Table No.1: Demographics of all the patients

Variable

Group 1

Group 2

P-value

Age (yrs)

226.36±6.48

25.93±6.23

N/S

Gender

Male

48 (60%)

43 (53.75%)

N/S

Female

32 (40%)

37 (46.25%)

N/S

BMI (kg/m2)

23.02±2.45

22.86±2.64

N/S

         

Table No.2: Operative findings of appendicitis

Variable

Group 1

Group 2

Total

Inflammation

70

65

135 (84.38)

Perforated

7

8

15 (9.38)

Gangrenous

5

5

10 (6.25)

 

Table No.3: Comparison of outcomes

Variable

Group 1

Group 2

P-value

Operative time

46.35±8.22

32.51±8.45

<0.001

Need for analgesic doses/day

1.26±0.86

2.84±0.75

0.002

Hospital stay

1.74±0.34

2.64±1.56

0.032

Wound infection

4 (5%)

13 (16.25%)

0.038

Return to routine activities (days)

11.44±3.28

15.64±4.71

<0.001

DISCUSSION

The two common surgical complications that involve immediate surgery are acute appendicitis. In the last two decades, laparoscopic surgery became a significant surgical development. Meta analyzes have confirmed a successful laparoscopic appendectomy and that there is an improved return to daily life at the cost of longer operating time and less wound complications.13,14 In present study majority of patients 56.88% were males and females accounted 43.12% with mean age 25.46±5.47 years. These results were comparable to many of previous studies in which male patients population was high 55% to 65% as compared to females and average age of patients was 24 years.15,16

We divided all the patients equally in to two groups, 80 patients in each group. One group received laparoscopic appendectomy and other received open procedure. We found no significant difference regarding age, gender and BMI between both groups. According to the operative findings, 135 (84.38%) patients (70 in group 1, 65 in group 2) had inflammative appendicitis, 15 (9.38%) patients (7 in group 1 and 8 in group 2) had perforated and 10 (6.25%) patients (5 in group 1 and 5 in group 2) had gangrenous appendicitis. A study conducted by Biondi et al17 reported that 85.2% in laparoscopic group and 69% in open group had uncomplicated appendicitis, 7.7% and 4.2% in open and laparoscopic groups had gangrenous appendicitis.

In present study we found that open appendectomy had significantly shorter operative time than laparoscopic appendectomy 32.51±8.45 minutes vs 46.35±8.22 minutes (p-value <0.05). These results showed similarity to some previous studies in which conventional appendectomy had significantly shorter operative time as compared to laparoscopic appendectomy.18,19

We found that laparoscopic appendectomy had significantly shorter hospital stay, less need for analgesic doses/day, less wound infection rate, and shorter time to return to routine activities as compared to open appendectomy 1.74±0.34 vs 2.64±1.56,

(1.26±0.86 Vs 2.84±0.75), (5% vs 16.25%), and (11.44±3.28 Vs 15.64±4.71) with p-value <0.05. Many of previous studies showed similarity to our findings in which patients treated with laparoscopic procedure had significantly shorter hospital stay, fewer postoperative complications and shorter time to return to daily activities as compared to open procedure.20,21 A study by Shimoda et al22 reported that laparoscopic appendectomy groups had significantly less blood loss, less rate of surgical site infection as compared to open appendectomy group with p-value <0.05.

Kolhar et al23 reported in their study that patients who underwent laparoscopic appendicectomy less discomfort following surgery, less analgesic use, fewer postoperative complications such as diarrhea, ileus, wound infection, reduced hospitalization and an quicker return to daily work.

CONCLUSION

Laparoscopic appendectomy safe and effective treatment modality due to shorter hospital stay, less rate of wound infection, shorter time duration to return to normal activities and less need for oral analgesic need.

Author’s Contribution:

Concept & Design of Study:

Barka Sajjad

Drafting:

Shoaib Muhammad

Data Analysis:

Tahirullah, Imran-ud-Din Khan

Revisiting Critically:

Barka Sajjad, Shoaib Muhammad

Final Approval of version:

Barka Sajjad

Conflict of Interest: The study has no conflict of interest to declare by any author.

REFERENCES

1.            Addiss DG, Shaffer N, Foweler BS, Tauxe R. The epidemiology of appendicitis and appendicectomy in the United States. Am J Epidemiol 1990;132:910–25.

2.            Kurtz RJ, Heimann TM. Comparison of open and laparoscopic treatment of acute appendicitis. Am J Surg 2001;182:211–4.

3.            Garbutt JM, Soper NJ, Shannon W, Botero A, Littenberg B. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc 1999;9:17–26.

4.            Grosso G, Biondi A, Marventano S, Mistretta A, Calabrese G, Basile F. Major postoperative complications and survival for colon cancer elderly patients. BMC Surg 2012;12 Suppl 1:S20.

 

 

5.            Stringer MD. Acute appendicitis. J Paediatr Child Health 2017;53:1071–6.

6.            Çiftçi F. Laparoscopic vs mini-incision open appendectomy. World J Gastrointest Surg 2015;7:267–72.

7.            Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, et al. Comparison of outcomes of laparoscopic versus open appendectomy in children: Data from the nationwide inpatient sample (NIS), 2006–2008. World J Surg 2012;36:573–8.

8.            Tan WJH, Pek W, Kabir T, Chan WH, Wong WK, Ong HS. Clinical outcome and cost comparison between laparoscopic and open appendicectomy. Ann Acad Med Singapore 2014;43:464–8.

9.            Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, et al. Laparoscopic versus open appendectomy for acute appendicitis: a meta-analysis. Surg Endosc 2011;25: 1199–208.

10.        Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2010;10:CD001546.

11.        Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015;386:1278–87.

12.        Tiwari MM, Reynoso JF, Tsang AW, Oleynikov D. Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis Ann. Surg 2011; 254(6): 927-32.

13.        Darwazeh G, Cunningham SC, Kowdley GC. A systematic review of perforated appendicitis and Phlegmon: interval appendectomy or wait-and-see? Am Surg 2016; 82(1): 11-5.

14.        Ioannis V, Constantinos F. Comparison between Open and Laparoscopic Appendectomy: A Systematic Review. World J Surg Surgical Res 2018; 1: 1004.

15.        Khalil J, Iqbal T. Ccompare laparoscopic and open appendectomy in terms of surgical site infection. Pak J Surg 2017; 33(3):174-80.

16.        Masoomi H, Nguyen NT, Dolich MO, Mills S, Carmichael JC, Stamos MJ. Laparoscopic appendectomy trends and outcomes in the United States: data from the Nationwide Inpatient Sample (NIS), 2004-2011. Am Surg 2014;80(10):1074-7.

17.        Biondi A, Grosso G, Mistretta A, Marventano S, Toscano C, Drago F, Gangi S, Basile F. Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery. BMC Surg 2013;13 Suppl 2:S12.

 

18.        Cipe G, Idiz O, Hasbahceci M, Bozkurt S, Kadioglu H, Coskun H, et al. Laparoscopic versus open appendectomy: Where are we now? Chirurgia (Bucur) 2014;109:518–22.

19.        Horvath P, Lange J, Bachmann R, et al. Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis Surg. Endosc 2017; 31(1): 199-205.

20.        Zhao L, Liao Z, Feng S, Wu P, Chen G. Single-incision versus conventional laparoscopic appendicectomy in children: a systematic review and meta-analysis. Pediatr Surg Int 2015; 31(4):347-53.

21.        Dai L, Shuai J. Laparoscopic versus open appendectomy in adults and children: a meta-analysis of randomized controlled trials. United European Gastroenterol J 2016, 5:542-53.

22.        Shimoda M, Maruyama T, Nishida K, Suzuki K, Tago T, Shimazaki T, et al. Comparison of clinical outcome of laparoscopic versus open appendectomy, single center experience. Heliyon 2018; 4(5).

23.        Kolhar BA, Lamani YP, Shekhar RM, Shankar G. Outcomes of laparoscopic versus open appendectomy: a comparative study. Int Surg J 2017;4:2185-8.