A two year retrospective review of Laparoscopic versus open Appendicectomy in perforated appendix in Hospital Ipoh (June 2006-May 2008)
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Date
2010-08
Authors
Krishnan, Nyanamalar
Journal Title
Journal ISSN
Volume Title
Publisher
Pusat Pengajian Sains Perubatan , Universiti Sains Malaysia
Abstract
Appendicectomy is one of the most common general surgical procedures
performed all over the world in the surgical department. Since its description by
McBurney in 1894 the open approach has become the standard surgical intervention
for appendicitis, remaining virtually unchanged for 100 years owing to its proven
efficacy and safety.
Laparoscopic appendicectomy on the other hand was first performed by Semm
in 1983 (Litynski, G.S. 1999).But its popularity increased steadily throughout the
1990s. However, unlike cholecystectomy, the benefits of the laparoscopic approach
have not been as apparent for appendicectomy, even more so in perforated
appendicitis. Many early randomized trials failed to show any overall benefit for
laparoscopy and others at best parity between the 2 procedures.
Current studies however indicate a shift in favour of laparoscopy, probably
due to the increase in laparoscopic exposure at all levels of surgical training. The aim
of this study is to compare certain parameters between Laparoscopic
appendicectomy with open appendicectomy.
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RESULTS: Two hundred and five patients with perforated appendicitis were
reviewed. Fifty-six patients had laparoscopic appendicectomy and one hundred and
forty nine patients had open appendicectomy. The median age in the laparoscopic
group was 28 and the open group was 30. The difference in the median age groups
was not statistically significant .The p value is 0.310. The mean (s.d) operating time
for laparoscopic appendicectomy was 69 minutes (29 minutes).The mean operating
time for the open group was 63 minutes (28 minutes). This study showed that there
was no significant difference in the mean length of operating time between the two
methods. The p value is 0.669. The mean (s.d.) length of hospital stay for the
patients in the laparoscopic group was 3.5days (1.6 days). In the open group the
mean length of hospital stay was 3.1 days (1.9 days). This was statistically not
significant (p=0.382).There was also no statistical significance in the duration the
patients took to tolerate orally and for the temperature to settle in both the groups.
There were a total of six patients with the surgical site infection and seven who had
readmission. Although all 6 patients with surgical site infection were from the open
group and none in the laparoscopic group this was not statiscally significant. p =
1.000. Five patients in the laparoscopic group and two in the open group were
readmitted within a week of their respective surgeries for ileus. This difference was
also not statistically significant with a p value of 1.000.The mean (s.d.) amount of
analgesia used in laparoscopic appendicectomy was 387.5mg (259.4mg) . The mean
(s.d.) for the use of analgesia in the open group was 274.5mg (204.3mg) for the open
group. This was statistically significant where p = 0.006.
CONCLUSION: There is no clinically significant difference between laparoscopic
appendicectomy and open appendicectomy for perforated appendicitis.
Description
Keywords
General Surgery