Page 56 - World Journal of Laparoscopic Surgery

ORIGINAL RESEARCH
Laparoscopic vs Open Appendectomy: Comparison on

Clinical Outcome

Ahmed Salim Khazaal

AbstrAct
Aim: In the past years, studies have reported the superiority of laparoscopic appendectomy (LA) over open appendectomy (OA) in randomized
studies. Hence, this prospective study was designed to evaluate the clinical outcome of LA compared to the OA.
Methods: All the patients who were diagnosed with appendicitis and visited Tikrit Teaching Hospital in the study period were included in this
study. They were divided into two groups: LA and OA groups. The two groups were compared on operating time, hospital stay, the incidence
of surgical site infection, and other postsurgical complications.
Results: In the present study, a total of 128 patients (who visited Tikrit Teaching Hospital in Iraq) were included. Among them, 63 were included
in the LA group and 65 people were in the OA group. The only significant difference that was observed in LA and OA group was in CRP count. In
the OA group, the CRP count was significantly higher compared to the LA group (p = 0.024). The mean operating time was almost comparable
between the LA and OA group. Blood loss was higher in the OA group and the difference was statistically significant (p = 0.038). Even hospital
stay was also shown to be statistically higher in the OA group. A significant difference was reported in the wound infection among the LA and
OA groups. In the OA group, wound infection was significantly higher (10.75%) than in the LA group (3.17%). No other adverse events were
reported to be statistically different.
Conclusion: Our findings revealed that LA has many advantages over OA, including a shorter hospital stay, earlier return to work, and a lower
risk of wound infection.
Clinical significance: LA significantly reduces postoperative complications and improves the surgical outcome.
Keywords: Appendicitis, Hospital stay, Laparoscopic appendectomy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1484

IntroductIon
Department of Surgery, College of Medicine, Tikrit University, Tikrit,
The most common surgical emergency encountered in any surgical Iraq
unit is appendicitis. It is the most common condition requiring Corresponding Author: Ahmed Salim Khazaal, Department of
appendectomy. The lifetime risk of appendicitis is 6%. In the general Surgery, College of Medicine, Tikrit University, Tikrit, Iraq, Phone:
population, acute appendicitis is reported in approximately 7–10% +7702097970, e-mail: ahmed.salim@tu.edu.iq
of people. The most commonly acute appendicitis is reported in How to cite this article: Khazaal AS. Laparoscopic vs Open
people who are in their second or third decade of life. 1 Appendectomy: Comparison on Clinical Outcome. World J Lap Surg
However, it was reported that the rate of morbidity associated 2022;15(1):54–57.
with open appendectomy (OA) is around 11% with an overall Source of support: Nil
mortality rate of 0.3%. 2 Conflict of interest: None
Laparoscopic appendectomy (LA) was introduced in 1983 by
a German gynecologist named Kurt Semm. After the introduction
of LA, it became popular. In the field of cholecystectomy, the Hence, it is quite evident that, unlike other laparoscopic
laparoscopic approach has become the gold standard and procedures, in appendectomy, there exists no consensus whether
encouraged by its success in this field even in other surgical fields; LA is a better option compared with OA. Further, it is also not clear
also this technique has gained popularity. 3 if this procedure can be performed regularly for all the patients.
In the past years, studies have reported the superiority of LA Moreover, in developing countries like India, there are not many
3,4
over OA in randomized studies. This technique had shown to studies that have been done in this field.
have advantages over OA procedures in terms of lower wound Hence, this prospective study was designed to evaluate the
infections, fewer incidences of vomiting, less pain, and also shown clinical outcome of LA compared to the OA including the hospital
to be associated with reduced hospital stays and faster recovery stay, operating time, development of postoperative complications,
5,6
time. In contrast, it was also reported that operating time is more and time to resume normal activity.
6
in the LA group and is associated with higher cost. Moreover, some
of the studies failed to show any higher efficacy of LA over OA. 7,8
The most common complication faced in the OA is the surgical MAterIAls And Methods
site infection (SSI). This is the most common problem that increases This prospective study was conducted in Tikrit Teaching Hospital
the hospital stay and cost of the procedure. It was noted that in in Iraq, from a period between May 2019 and December 2020. At
OA the chances of SSI are more and this significantly increases the the beginning of the study ethical clearance was taken from the
length of the hospital stay. 9 institutional ethics committee. All the patients who were diagnosed

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