Laparoscopic vs Open Appendectomy : A Comparative Study

Abstract

Backgraound: Open appendectomy (OA) has been the treatment of choice for acute appendicitis since its introduction by Mc-burney in 1884. Laparoscopic appendectomy(LA) though widely practiced, has not gained universal approval. LA was first described in 1983. Some early studies showed equivocal results about benefit of LA. Recent studies showed overall benefit in favour of LA. So far no such a large study was done in any Bangladeshi hospital. So, we decided to do this study with a view to evaluate the therapeutic benefit of LA by comparing with conventional OA . Materials and methods: We collected data of 763 appendectomies done in Jahurul Islam medical college hospital from July 2007 to June 2012 for a period of 5 years. Out of them 448 had conventional OA and 315 had LA. We compared the mean operation time, time of first oral feeding, narcotic analgesic requirement, duration of post operative hospital stay. Results: We found that mean operation time was 33±5.8 minute and 37± 7.5 minute in LA and OA 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. Conclusion: Our 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 stay and less requirement of narcotic analgesic.

Comparative Study of Surgical Site Infection between Laparoscopic Appendectomy and Open Appendectomy

“…In study of Biondi et al 13 showed the mean ± standard deviation (SD) operative time of 54.9 ± 14.7 min for the LA group was longer than the mean operative time of 31.36 ± 11.43 min for open appendectomy (P <0.0001). In another study of Islam et al 19 showed the operating time in LA was 33±5.8 minutes and in OA was 37±7.5 minute (OR-0.79, CI-95%). In my study it was observed that port site infection occur in two groups, which was 14% in OA group and 10% in LA group.…”

Comparative evaluation of laparoscopic versus open appendicectomy in cases of acute appendicitis

“…Islam and Pasha et al in a Bangladeshi study of 763 appendicectomies also noted these advantages of laparoscopic appendicectomy over open appendicectomy. 15 A retrospective analysis by Biondi et al noted similar beneficial effects of laparoscopic appendicectomy. 16 A large meta-analysis of 7618 laparoscopic 43757 open appendicectomies also found shorter hospital stay after laparoscopic appendicectomy.…”

Outcome comparison study between laparoscopic appendisectomy and conventional open appendisectomy

“…This study was similar to the study done by Islam et al where LA time is less than OA time. 10 This might be due to the learning curve the surgeon had experienced that operation time in LA was being lesser when compared to the time we started doing LA. There were average of 10-minutes difference between LA and OA.…”