Comparative Outcomes of Laparoscopic Versus Open Appendectomy in Complicated Appendicitis: A Prospective Clinical Study
Laparoscopic vs. Open Appendectomy in Complicated Appendicitis: Outcomes
DOI:
https://doi.org/10.69750/dmls.02.07.0139Keywords:
Laparoscopic appendectomy, Open appendectomy, Complicated appendicitis, Postoperative outcomes, PakistanAbstract
Background: Complicated appendicitis, characterized as perforated, gangrenous, or abscessed appendix is a common surgical emergency with morbidity that is greater than uncomplicated disease. Open appendectomy (OA) has long been the standard of practice but laparoscopic appendectomy (LA) is being increasingly used because of the advantages that it could have on pain management, wound healing and recovery. Its use in the complicated cases is however controversial especially in low- and middle-income countries.
Objectives: To make a comparison between the results of laparoscopic and open appendectomy in tertiary care hospitals of Pakistan in patients with complicated appendicitis.
Methods: A prospective clinical trial was conducted at the general surgery departments of two tertiary care hospitals in Pakistan, between March 2023 and March 2024. Sixty patients aged 15 to 60 years with intraoperative confirmed complicated appendicitis were randomly grouped into two equal samples; LA (n=30) and OA (n=30). The outcomes measured were: operative time, postoperative pain (VAS), wound infection, intra-abdominal abscess, hospital stay and return to normal activity. The SPSS v26 was used to conduct the statistical analysis with significant value of p < 0.05.
Results: The mean time taken during operations was higher in LA (84.6 ± 14.8 minutes) as compared to OA (66.2 ± 12.9 minutes, p<0.001). At 24 and 48 hours, LA experienced less postoperative pain (p<0.001) with 4.1 and 2.8, respectively. The infection rate of the wound was lower in LA (6.7% vs. 20%, p=0.04) whereas the rate of intra-abdominal abscess was equal (10% vs. 6.7%, p=0.64). The patients of LA had reduced hospitalization (3.6 ± 1.1 vs. 5.3 ± 1.4 days, p<0.001) and quicker recovery (9.4 ± 2.5 vs. 14.7 ± 3.3 days, p<0.001).
Conclusion: Laparoscopic appendectomy is a better and safer alternative to open appendectomy in complicated appendicitis. Although it has a longer operating period, it provides less pain, less wound infection, less hospitalization and faster functional recovery which makes it more useful in tertiary care Pakistan hospitals.
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