Background: Open appendectomy is one of the most common surgeries done in an emergency operation theatre even after three decades of introduction of laparoscopic surgeries. The previous studies done on laparoscopic appendectomy produced conflicting recommendations, and the adequacy of sample sizes is generally unknown. We compared primary outcomes after laparoscopic and open appendectomy in a sample of predetermined statistical power.Methods: A pre-study power analysis suggested that 200 randomized patients would yield 80% power to show a mean decrease of 1.3 days hospitalization. One hundred ninety-eight patients with a preoperative diagnosis of acute appendicitis were randomized prospectively to laparoscopic or open appendectomy. The primary outcomes measured were duration of operative time, postoperative pain and analgesia, length of hospital stay and cosmetic advantages.Results: It was found that mean operation time was 33±5.8 minute and 37± 7.5 minute in OA and LA respectively. Duration of post-operative hospital stay was 1.2 days shorter in Laparoscopic group. LA required 1.1 shots of less analgesic than OA. Oral feeding was resumed 21 hours earlier following LA compared to OA. Laparoscpic appendectomy was safely performed in paediatric patient without any adverse effect. We also found that, in female patient, concurrent ovarian cysts, tubal pregnancy and endometriosis can be diagnosed and managed laparoscopically in the same sitting.Conclusions: Present study found that laparoscopic appendectomy is an effective and safe procedure irrespective of age and sex of the patient. LA has added advantage of early return of bowel movement, less post-op hospital stays and less requirement of narcotic analgesic.
BACKGROUND The Modified Alvarado Scoring System (MASS) has been shown to be easy, simple and cheap diagnostic tool for supporting the diagnosis of acute appendicitis. However, its application and usefulness has not been evaluated in the current study settings in the diagnosis of acute appendicitis. Hence, this study was conducted. Objectives-1. To evaluate the specificity and sensitivity of Modified Alvarado Scoring System in the diagnosis of Acute Appendicitis. 2. To assess the rate of negative laparotomies. MATERIALS AND METHODS A cross-sectional study was conducted for a period of 18 months among 107 patients presenting at the surgery OPD, Sri Siddhartha Medical College Hospital and Research Centre, Tumkur, with complaints of pain in right iliac fossa with suspected features of acute appendicitis. The informed consent was taken. After considering the inclusion and exclusion criteriae, study subjects were categorised based on modified Alvarado scoring system. The subjects with ≥ 7 were made to undergo appendicectomy and those with score < 7 were re-scored after conservative management. The pre-operative diagnostic accuracy was evaluated. RESULTS The mean age of the study participants was 26.54 ± 10.46 yrs. and majority were males. Most frequent complaint was nausea and/or vomiting. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and diagnostic accuracy were 97.4%, 79.3%, 92.7%, 92.0%, 92.5% respectively. Negative appendicectomy rate was 7.3%. CONCLUSION MASS score of ≥ 7 is found to be having high sensitivity, PPV, NPV and good specificity, hence can be used as diagnostic indicator of acute appendicitis in the low resource setting.
INTRODUCTIONInguinal hernias constitute the most common form of abdominal wall hernias. The incidence of inguinal hernia remains indefinite; however, nearly about 500,000 cases come to medical attention each year. Twenty or more years ago, international and US surveys were conducted, wherein, the non-surgically treated inguinal hernia prevailed among 5% of men and similarly, same number of men had history of hernia repair.1 The lifetime risk of inguinal hernia is estimated to be 27% and 3% for men and women respectively. Inguinal hernia repair is one of the commonly performed general surgeries among both adults and children accounting for more than 95% of all groin hernia repairs. 3Collective Indian data are limited.4 However in few of the Indian studies, the prevalence of inguinal hernias among ABSTRACT Background: The study was conducted to compare and assess the duration of procedure, complications encountered, post-operative pain and recovery, duration of hospital stay, and time taken in resumption to work between two techniques of open Lichtenstein mesh repair (OLMR) and Totally extra peritoneal (TEP) repair in the low resource settings. Methods: A cross sectional comparative study was conducted among 50 male patients admitted for surgical repair of hernia. After considering the inclusion and exclusion criteria, the subjects were randomly assigned to the groups of OLMR and TEP and were assessed for pain in the post-operative period was rated using a Visual Analogue Scale. Total duration of the procedure, complications, duration of hospital stay, and time taken in resumption to work were elicited between two techniques. A p-value of <0.05 was taken as statistically significant. Results: The mean duration of surgery among the study participants in TEP (49.60+3.62 mins) group was significantly higher compared to OLMR (45.96+4.63 mins) group (p=0.003). The median of post-operative pain scores in TEP group was significantly lower compared to OLMR group. The mean duration of post-operative recovery time (3.08+0.4 days), for resumption to work (5.08+0.28 days) among the study participants in TEP group was significantly lower compared to OLMR (5.00+0.00 days), (10.08+0.76 days) (p<0.001) respectively. The complications were significantly higher among the OLMR group (100.0%) compared to the TEP group (p<0.05). Conclusions: Though the procedure of TEP repair for inguinal hernia takes a little longer time and complications of general anaesthesia cannot be ruled out, it is a better procedure compared to open type.
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