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OUT COMES OF LAPAROSCOPIC APPENDECTOMY VERSUS OPEN APPENDECTOMY IN EMERGENCY-A RANDOMIZED CONTROLLED CLINICAL TRIAL

Dr. Zardad Khan, Azhar Hussain

Background: Acute inflammation of appendix, known as appendicitis can be due to infection or obstruction of appendix by stool, foreign bodies or cancer. The etiology of appendicitis is multifactorial and it is the most common presentation of acute abdomen. Aim: The aim of this research is to compare the effectiveness and safety of laparoscopic and conventional open appendectomy in the treatment of acute appendicitis in local tertiary care settings on Pakistani population by comparing data pertaining to the two procedures especially with regards to post op pain, hospital stay duration, wound infection and cost effectiveness. Methods: After the approval from Ethical review committee of Lahore General Hospital all cases of acute appendicitis were identified for this randomized controlled clinical trial as per the inclusion exclusion criteria. After written informed consent, appendectomy were done patient and patients were interviewed. Postoperative pain were measured by Numerical Rating Scale (NRS) in which the value 0 indicate no pain at all and 10 is equal the worst pain ever felt. Surgical record were used for preoperative and postoperative treatment, procedure done, and duration of hospital stay. Alvarado scoring system of clinical diagnosis for acute appendicitis Results: We studied on 600 patients. 398(59.2%) were female, 202(40.7%) were male. 93.1% were married and 6.9% were unmarried. The number of laborers was 56.2%, housewives were 37.9% and government employed working ladies were 6%. On screening through ELISA or PCR, out of 600 subjects, only 4 (0.67%) were positive for hepatitis C infection. During study period, total 763 appendectomy were performed, of which 448 were open and 315 were laparoscopic. The post-operative hospital stay was 4.4 days in OA and 3.2 in LA (OR-0.47, CI95%). Conclusion: Laparoscopic appendectomy is better than open appendectomy with regards to post op pain, hospital stay duration and wound infection. Keywords: Laparoscopic appendectomy, open appendectomy, emergency.

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