Laparoscopic Versus Open Appendectomy- A Randomized Control Trial

Atia Khatoon; Muhammad Fahim; Wajiha Tehniyat; Sadia Ijaz Abbasi; Jahangir Sarwar Khan; Muhammad Mussadiq Khan; Fahad Sarwar; Rana Shahbaz

Background: To compare operative time of procedure and post-operative pain after laparoscopic (LA) versus open appendectomy (OA). Methods: In this randomized control trial 98 patients who presented in emergency department with signs and symptoms of acute appendicitis were randomly allocated into two groups for open (OA) and laparoscopic appendectomy (LA). Laparoscopic appendectomy was performed via 3 ports, an infraor supraumbilical 11-mm port inserted by the closed (veress needle) and a 45 degree laparoscope were inserted to examine the abdomen. Two additional ports were inserted under direct vision in the right iliac fossa and either the left iliac fossa or above the pubis. The appendix was then transected by a stapler. The specimen was removed by extractor. In case of an open appendectomy, a Gridiron or Lanz incision was made in right iliac fossa.The appendix base was closed by Vicryl 1 ligature.Operative time for both the procedures was measured in minutes starting from time of incision and ending at closure of the skin. Postoperatively, pain was assessed by visual analogue scale four hours after surgery . All quantitative data (operative time) was compared by independent sample test. All qualitative data(postoperative pain) was compared by chi square test. A p-value < 0.05 was considered statistically significant. Results: Out of 98 patients (49 patients in each group), there were 37 male and 61 female.. The mean age in OA group was 20.18+7.56, and in LA group 22.24+6.96.The mean operative time in OA group was 33.84 +13.20 minutes while in LA group it was 37.67+ 11.07 minutes. Patients in LA group experienced less postoperative pain as compared to OA group. Mean VAS in OA group was 7.08 +1.93 and in LA group was 3.84+ 1.84 which is statistically significant (p<0.05). Conclusion: Laparoscopic appendectomy is better than open appendectomy for treatment of acute appendicitis in terms of post-operative pain and operative time is same in both of the approaches.