A prospective randomized comparison of primary outcome between laparoscopic appendectomy and open appendectomy

Authors

  • Shivakumar T Department of General Surgery, Sri Siddhartha Medical College, Karnataka, India
  • Ved Prakash Ranjan Department of General Surgery, Sri Siddhartha Medical College, Karnataka, India
  • Yamuna V. S. Department of General Surgery, Sri Siddhartha Medical College, Karnataka, India
  • Karthik P. Department of General Surgery, Sri Siddhartha Medical College, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20174503

Keywords:

Acute appendicitis, Laparoscopic appendectomy, Laparoscopic versus open appendectomy, Open appendectomy

Abstract

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.

References

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25.

McBurney IV C. The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg. 1894;20(1):38-43.

Semm K. Endoscopic appendectomy. Endoscopy. 1983;15(2):59-64.

Becker LA, Oxman AD. Chapter 22: Overviews of reviews. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.

Smith V, Devane D, Begley CM, Clarke M. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol. 2011;11(1):15.

Hartling L, Chisholm A, Thomson D, Dryden DM. A descriptive analysis of overviews of reviews published between 2000 and 2011. PLoS One. 2012;7(11):e49667.

Pieper D, Buechter R, Jerinic P, Eikermann M. Overviews of reviews often have limited rigor: a systematic review. J Clin Epidemiol. 2012;65(12):1267-73.

Pieper D, Antoine SL, Mathes T, Neugebauer EA, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol. 2014;67(4):368-75.

Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N, Ortiz Z, et al. External validation of a measurement tool to assess systematic reviews (AMSTAR). PLoS One. 2007;2(12):e1350.

Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10.

Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clini Epidemiol. 2009;62 (10):1013-20.

Bennett J, Boddy A, Rhodes M. Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutan Tech. 2007;17(4):245-55.

Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: a meta-analysis. J Am Coll Surg. 1998;186(5):545-53.

Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X, et al. Laparoscopic versus conventional appendectomy–a meta-analysis of randomized controlled trials. BMC Gastroenterol. 2010;10:129.

15. Liu Z, Zhang P, Ma Y, Chen H, Zhou Y, Zhang M, et al. Laparoscopy or not: a meta-analysis of the surgical effects of laparoscopic versus open appendicectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(6):362-70.

Meynaud-Kraemer L, Colin C, Vergnon P, Barth X. Wound infection in open versus laparoscopic appendectomy. Int J Technol Assess Health Care. 1999;15(2):380-91.

Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K. Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis. J Gastrointest Surg. 2012;16(10):1929-39.

Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;10:CD001546.

Temple LK, Litwin DE, McLeod RS. A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis. Can J Surg. 1999;42(5):377-83.

Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, et al. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc. 2011;25(4):1199-208.

Jaschinski T, Mosch C, Eikermann M, Neugebauer EA. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol. 2015;15:48.

Stefano A, Ferrara F, Bellia A, Vacante M, Piazza L. Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emerg Surg. 2016;11:44.

Dai L, Shuai J. Laparoscopic versus open appendectomy in adults and children: a meta-analysis of randomized controlled trials. United Eu Gastroenterol J. 2017;5(4):542-53.

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Published

2017-09-27

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Original Research Articles