Page 10 - World Journal of Laparoscopic Surgery

Laparoscopic vs Mini-incision Open Appendectomy
Table 2: Comparison based on postoperative complications in two groups
Group MIA Group LA
Postoperative complications Number of patients % Number of patients % p-value
Wound infection 6 11.5 0 0.0 0.027*
Adhesion obstruction 3 5.8 0 0.0 0.243
Intra-abdominal abscess 2 3.8 1 2.0 1.000
Ileus 4 7.7 0 0 0.118
*Statistically significant difference (p <0.05)
Complications were seen in 11 patients who underwent MIA. Wound infection is the most common postoperative compli-
It included wound infection in 6 (11.5%), intra-abdominal abscess cation seen in 5–10% patients after open appendectomy. The other
in 2 (5.8%) and ileus in 3 (7%) patients (Table 2). On the other hand, complications reported include intra-abdominal abscess (8%) and
only one patient with LA had a postoperative complication in the ileus mostly seen following removal of gangrenous appendix.
form of intraabdominal abscess. The difference between the two Another rare complication reported is the leakage from appendicular
groups as far as the wound infections is concerned was statistically stump, which may occur if the encircling stitch has been put too
significant with p = 0.027 in favor of LA (Table 2). deeply resulting into a faucal fistula. Subacute intestinal obstruction
A total of 36 (73.5%) patients from LA group resumed orals due to postoperative adhesions is most common late complication
within 12 hours after surgery while more than 84% patients from of open appendectomy. Laparoscopic appendectomy combines
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MIA group resumed orals 24 hours after surgery. The difference was the advantages of diagnosis and treatment in one procedure. With
statistically significant with p <0.001 in favor of LA. the development of laparoscopic technique, it has been used for
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All 52 patients belonging to MIA group had hospital stay for both diagnosis and treatment of acute appendicitis. Advantages
more than 30 hours, while out of 49 patients belonging to LA of LA include lower hospital stays, shorter recovery period, lower
group, 44 (89.8%) had a hospital stay of less than 30 hours, and postoperative pain, lower postoperative infections, and early
remaining 5 (10.2%) patients had stay of more than 30 hours, which return to daily activities. 14–16 Several prospective randomized
was statistically significant with p <000.1. The 5 patients from LA studies have been carried out to compare outcome of laparoscopic
group who had hospital stay of more than 30 hours had delayed and open appendectomy, and the overall differences have been
onset of bowel sounds with postoperative abdominal distension, found to be insignificant. The percentage of appendectomies
which was managed conservatively. performed laparoscopically continues to increase. In contrast to
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In this study, 31 (63.3%) patients from LA group returned to open appendectomy, patients with perforated appendicitis have
routine work by 1 week while 2 (3.8%) patients from MIA group and been reported to have lower rates of wound infections following
16 (32.7%) patients from LA group returned to routine work by 1–2 laparoscopic procedure. 18
weeks. On the other hand, 50 (96.2%) patients from MIA group and In this study, the mean operative time in MIA group was 32.7
2 (4.1%) patients from LA group returned to routine work after 2 (2.52) minutes while in LA group, the mean operative time was
weeks. The p-value was statistically significant (<0.001) in favor of LA. 26.9 (2.46) minutes. Laparoscopic appendectomy was less time
consuming as compared to MIA with a significant p <0.001. The
dIscussIon results of this study were similar and comparable to the results of
Surgical intervention is the most common modality of management the study conducted by Özsan et al. with a mean operative time of
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for acute appendicitis. Gridiron incision is the most common 21.34 ± 8.39 in LA and a mean operative time of 28.32 ± 5.87 in MIA.
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approach utilized when diagnosis of appendicitis is reasonably This study was also comparable to Islam et al. with an operating
certain. In case the need arises, the gridiron incision may be time of 33 (5.8) in LA and operating time of 37 (7.5) minutes in
converted to a muscle cutting Rutherford Morison incision for better MIA. The results of this study were not comparable to the study of

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exposure. Another popular incision employed widely is a transverse Naraintran et al., inwhich LA had taken a mean time of 68.5 (20.3)
skin incision located approximately 2 cm below the umbilicus with minutes and open appendectomy had taken a mean time of 48.2
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its center on the mid-clavicular-mid-inguinal line. The exposure is (12.4) minutes (p <0.001). In a study by Kushwah et al., the mean
better with this type of incision and the incision may be extended operating time was 60.8 and 45.7 minutes for laparoscopic and open
medially either by retraction or by division of the rectus abdominis appendectomy, respectively.
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muscle if need arises. Mini-incision appendectomy is done either In this study, total of four patients from MIA group had bleeding
in general or spinal anesthesia. For the mini-incision approach, intraoperatively which was managed by electrocoagulation at the
an abdominal examination is done and the most painful point is same time, while none of the patients from LA group had bleeding
identified and marked preoperatively. From that marked point, a intraoperatively, with p = 0.118.
2.5–3 cm oblique incision is made instead of classical McBurney’s In this study, three patients from the MIA group had iatrogenic
incision appendix is delivered through the incision by using an injury (two had injury to caecum and one to terminal ileum) while
index finger. Mesoappendix is identified and ligated by 2/0 silk handling tissue which were repaired at the same time by primary
suture and finally divided. Base of appendix is transfixed using 2/0 suturing and putting a drain. None of the patients in LA group had
vicryl suture (Fig. 3). The knot at the base is further secured using any iatrogenic injury (p = 0.243).
2/0 silk suture to prevent stump leak. The peritoneum and fascia In this study, the hospital stay was significantly less in those
are approximated using 2/0 vicryl sutures. The incision in the skin who underwent laparoscopy as compared to those who underwent
is closed by using 1/0 non-absorbable suture. MIA group with a statistically significant p <0.001 in favor of LA.

196 World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022)