Page 58 - World Journal of Laparoscopic Surgery

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Table 4: Number of postoperative complications with the previous studies that have reported a similar lower
Postoperative complication LA (N = 63) OA (N = 65) p value operating time in LA group. 3–5
Usually, a longer operating time in LA occurs because of the
Surgical site infection (SSI) 2 (3.17%) 7 (10.75%) 0.002 lower experience of the surgeons performing the surgeries. Two
PONV 30 (47.61%) 20 (30.76%) 0.62 factors are usually dependent on the experience of the surgeons:
Intra-abdominal abscess 1 (1.58%) 1 (1.53%) 0.15 blood loss and operating time. With the increased experience of
Readmission 0 0 the surgeon the blood loss and operating time both decrease.
Even, the pathological conditions of appendicitis also dictate
15
Table 4 describes the postoperative complications reported the amount of blood loss and operating time. In our study also
in the follow-up period. A significant difference was reported in blood loss was significantly lower in the LA group compared to
the wound infection among the LA and OA groups. In the OA the OA group.
group wound infection was significantly higher (10.75%) than in The present study also reported a shorter hospital stay for
the LA group (3.17%). No other adverse events were reported to the patients who underwent the LA procedure. Hospital stay is
be statistically different. another factor that increases the cost of the operation and poses
an economic burden on the patient. Though we did not compare
the cost of both the technique, it is quite apparent that the cost
dIscussIon will be lower in the LA group. Our result is consistent with the
Appendicitis is the most common condition that requires surgical early studies that pointed out significant lower hospital stay in
intervention. Any patient presenting with an acute abdomen LA group. 11,16
should always consider appendicitis, and proper diagnosis of the Patients who had undergone OA took more time to get back
10
condition still poses a challenge. Laparoscopic surgeries have to their normal activities (15 ± 3.1). On the other hand, patients
gained much attention in the last decade. In gall stone diseases who underwent the LA took less time to resume normal activity
and many other surgical procedures, the laparoscopic technique (12 ± 2.3). Our study also reported lower incidences of SSI in the LA
has proved to be effective and safe. 11 group. In the OA group, wound infection was significantly higher
After the first report of LA was reported in 1999 in Taiwan, (10.75%) than in the LA group (3.17%). This could be because in OA
this technique became popular worldwide. In many of the direct exposure of the wound site occurs in the procedure. Whereas,
studies, comparison of this technique with the OA was done and in the LA, the specimen was removed using an extraction bag. This
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it was demonstrated that this technique is well tolerated. 11–13 This finding also is similar to the previous finding by Shimoda et al.
technique has several advantages over the open procedures in However, the instances of PONV were higher in the LA group. None
several surgical sections being a minimally invasive surgery. It of the group patients required readmission.
was also shown that this procedure with regard to less pain, lower
recovery time, and better cosmetic appearance had some of the conclusIon
advantages that this technique has over the OA procedure. 13 Our findings revealed that LA has many advantages over OA,
However, contrasting opinions are also available that have including a shorter hospital stay, earlier return to work, and a
reported not many changes between the LA and OA approaches. lower risk of wound infection. Also, we discovered that patients in
Hence, no consensus idea exists on this topic. In this present study, the laparoscopic group had a strong preference (during consent
the clinical outcome between the OA and LA was conducted and we collection) and high satisfaction after surgery.
hope that the study results will be able to help future researchers
to conduct a large cohort study. Clinical Significance
In the present study among the total 128 patients, 63 were LA should be considered secure and similarly effective to open
included in the LA group and 65 people were in the OA group. surgery if surgical experience and equipment are available. It could
No statistically significant difference was observed between be used as the first treatment of choice in most cases of suspected
both the groups with respect to age, gender, WBC count, and appendicitis, as it significantly reduces postoperative complications
co-morbidities. However, in the level of C-reactive protein and improves the surgical outcome.
(CRP), a significant difference was observed between LA and CA
patients. Patients who underwent OA had a higher level of CRP references
compared to the LA group. In the past, it was reported that CRP
level can predict the occurrence of SSI in appendectomy cases 1. Kurtz RJ, Heimann TM. Comparison of open and laparoscopic
treatment of acute appendicitis. Am J Surg 2001;182(3):211–214. DOI:
independently. 14 10.1016/s0002-9610(01)00694-8.
In the study participants, maximum of the patients had 2. Guller U, Hervey S, Purves H, et al. Laparoscopic versus
uncomplicated acute appendicitis and gangrenous appendicitis open appendectomy: outcomes comparison based on a large
was reported in 4.76% of the cases in the LA group and 9.23% of administrative database. Ann Surg 2004;239(1):43. DOI: 10.1097/01.
the patients in the OA group. This is also an interesting finding as sla.0000103071.35986.c1.
other than CRP level pathology of the condition has also shown to 3. Shaikh AR, Sangrasi AK, Shaikh GA. Clinical outcomes of laparoscopic
be associated with the SSI among appendectomy patients. 14 versus open appendectomy. JSLS 2009;13(4):574–580. DOI: 10.4293/
108680809X1258998404524.
In the present study, longer operating time was reported in 4. Hellberg A, Rudberg C, Kullman E, et al. Prospective randomized
the OA group. In the LA group, the operating was almost 4 minutes multicentre study of laparoscopic versus open appendicectomy. Br
slower than the OA group. However, this difference was not found J Surg 1999;86(1):48–53. DOI: 10.1046/j.1365-2168.1999.00971.x.
to be statistically significant. The operating time measured in this 5. Ortega AE, Hunter JG, Peters JH, et al. A prospective, randomized
study is skin-to-skin time. This present study result is in accordance comparison of laparoscopic appendectomy with open

56 World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022)