Page 7 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Clinical Outcomes of Laparoscopic vs Mini-incision

Open Appendectomy: A Comparative Study

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Shams Ul Bari , Aamir Farooq 2
Received on: 01 August 2022; Accepted on: 06 September 2022; Published on: 07 December 2022

AbstrAct
Introduction: Open appendectomy was first introduced by McBurney and has been considered as the treatment of choice for more than a
century for acute appendicitis. However, recently, laparoscopic appendectomy (LA) has become the popular method of treatment for patients
with acute appendicitis.
Aims and objectives: The aim of this study was to compare results of LA with mini-incision open appendectomy in terms of various parameters
such as time taken to complete the procedure, postoperative pain, need for analgesia, hospital stay, days to return to normal activity cosmetic
results, and complications.
Material and methods: This study was a prospective study conducted in the Department of Surgery, SKIMS Medical College, Bemina, Srinagar,
Jammu and Kashmir, India, from July 2017 to June 2019. All patients more than 14 years in age admitted in the accident emergency department
of the hospital with a clinical diagnosis of acute appendicitis were included in the study.
Results and observations: Total number of patients studied was 101 and were randomly taken either for mini-incision open appendectomy
or laparoscopic surgery. The two groups were comparable with respect to age and sex distribution with no statistically significant difference.
The average operative time in mini-incision appendectomy (MIA) group was 32.7 ± 2.52 (30–35 years of age) compared to 26.9 ± 2.46 (24–30
years of age) in laparoscopic group, which was statistically significant. The patients with laparoscopic surgery experienced less pain and had
less postoperative wound infection as compared to MIA group with p <0.001, which was statistically significant.
Conclusion: Comparison done on the basis of statistical results between the two groups was suggestive of superiority of LA over MIA.
Keywords: Appendectomy, Appendicitis, Laparoscopy, Pneumoperitoneum, Visual analog scale.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1479

IntroductIon
Claudius Amyand, a French surgeon performed first successful 1,2 Department of Surgery, SKIMS Medical College and Hospital,
appendectomy in 1735, on an 11-year-old child. The appendix was Bemina, Srinagar, Jammu and Kashmir, India
found inside the inguinal hernia sac and had been perforated by the Corresponding Author: Shams Ul Bari, Department of Surgery, SKIMS
pin. The standard technique for removal of appendix by a muscle Medical College and Hospital, Bemina, Srinagar, Jammu and Kashmir,
splitting incision was first described in 1894 by McBurney. Since India, Phone: +91 9419753596, e-mail: shamsulbari@rediffmail.com
then, open appendectomy has remained as a treatment of choice How to cite this article: Ul Bari S, Farooq A. Clinical Outcomes of
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for acute appendicitis. The overall mortality and morbidity rate for Laparoscopic vs Mini-incision Open Appendectomy: A Comparative
open appendectomy has been reported as 0.3 and 11%, respectively. Study. World J Lap Surg 2022;15(3):193–198.
Laparoscopic appendectomy, first described by Kurt Semm in Source of support: Nil
1983, is now widely accepted as method of choice for management Conflict of interest: None
of acute appendicitis among surgeons using a three-port technique.
Although laparoscopic cholecystectomy is presently considered
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as the treatment of choice for gallstone disease, LA has yet not While managing patients with suspected appendicitis,
been accepted as a surgery of choice for appendicitis. In several particularly in women of child bearing age, laparoscopy is an
randomized comparisons studies, LA has been proved to be important diagnostic tool to rule out other causes of lower abdominal
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safe and viable method for removal of appendix. Advantages of pain. For assessment of benefits of laparoscopy, several prospective
10,11
7–9
LA include improved diagnostic accuracy, lesser wound related randomized trials, meta-analyses and systematic reviews have
complications, less pain, fast recovery, and early return to routine been conducted. However, there is no consensus in the literature
work. The disadvantages of laparoscopy include more operating about whether to take all patients with appendicitis for laparoscopy
time and increased hospital costs. 3,4 As reported by several or to reserve it only for selected cases such as young females in a
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comparative studies, laparoscopy is an ideal alternative to open reproductive age-group, obese patients, and professional workers.
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appendectomy for patients with suspected appendicitis. Although
LA is associated with lesser postoperative wound infections, in AIms And objectIves
patients with gangrenous and perforated appendicitis, higher The aim of this study was to compare LA with mini-incision-open
incidence of postoperative intra-abdominal sepsis has been appendectomy in terms of operating time from the start of incision
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reported. Several studies have concluded that although the cost and the end of procedure, intraoperative complications if any,
of laparoscopy is high, the benefit is minimal. postoperative pain score on visual analog scale (VAS), postoperative
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