Appendectomy Open Versus Laparoscopic in Developing World Scenario

Abstract

Background: Laparoscopic surgery is an expanding field which is recognized as gold standard for cholecystectomy, it is being increasingly used by many surgical subspecialties with advantage of being minimal invasive and being both diagnostic and therapeutic. Objectives: This study was done to evaluate the feasibility of laparoscopic appendectomy in a developing world scenario.Material and Methods: This observational cross-sectional study was conducted under department of general surgery from September 2019 to August 2021. The patients presenting to the ER department were evaluated based on Alvarado score. Alternate patients underwent laparoscopic appendectomy (LA) and open appendectomy (OA). Based upon clinical and imaging signs of acute appendicitis (i.e. Alvarado score of 7 or more) and consent to be the part of study, were used as inclusion criteria, while pregnancy, patients who could not tolerate increased intra-abdominal pressure/prolonged anesthesia, patients under 10 years of age and patients with evidence of appendicular mass formation were excluded from the study. The standard surgical techniques were performed for both groups and the patients were followed up in immediate post-operative period, at 6 months and one year. Results: The parameters observed were duration of surgery average 25 minutes (range 15-50 mins) for OA and 70 minutes (range 40-90 mins) for LA (P-Value 1.41E-70), return to preoperative activity level was 13 days (range 10-17 days) for OA and 10 days (range 9-14 days) for LA (P-Value 6.69034E-22), and average cost for OA was PKR 35279.00 while for LA was PKR 72168.00 (P-Value 1.24442E-60). Remaining parameters were not significantly different.Conclusion: The evidence available clearly demonstrates that laparoscopic appendectomy is superior to open appendectomy in terms of hospital stay, post-operative pain and return to work, however in a few situations the procedure needs to be converted therefore the surgeon must be conversant with open appendectomy for complicated case. Moreover, cost is a major factor determining the choice of procedure specially in the developing countries. Keywords: Appendectomy, Developing world, Laparoscopic Appendectomy, Open versus Laparoscopic Appendectomy, Pakistan,