Randomized Controlled Trial Comparing Open, Conventional, and Single Port Laparoscopic Appendectomy PC05-PC10
Dr. Varun Kumar Singh,
Assistant Professor, Department of Surgery, Sikkim Manipal Institute of Medical Sciences,
5th Mile, Tadong, Gangtok-737102, Sikkim, India.
Introduction: Open appendectomy took decades to evolve to establish itself as the treatment for appendicitis. Then came the era of laparoscopy, which unlike in case of cholecystectomy, faced quite resistance and still has not become the treatment of choice. What followed was the reduction in the size and number of ports. Single port laparoscopic appendectomy and Natural Orifice Transluminal Endoscopic Surgery (NOTES) were the further developments.
Aim: To evaluate the status of appendectomy in patients with simple appendicitis through the three approaches: Open Appendectomy i.e. OA, Conventional Laparoscopy Appendectomy i.e. CLA and Single Port Laparoscopic Appendectomy (SPLA)/Incision Approach.
Materials and Methods: The study was designed as a double blinded randomised controlled trial and included the patients aged 12-50 years who had simple uncomplicated appendicitis and underwent appendectomy over a duration of 18 months.
Results: Mean age of patients was 31.27, 27.4 and 27.64 years and female to male ratio was 1.14, 1.5 and 1.33 for OA, CLA and SPLA arm, respectively. Overall duration of presentation was two days and most of the patients were under BMI of 25. The appendix was the first visualized organ in less than half of the total patients and a little over half had adhesions. The most common location of the appendix was paracaecal followed by pelvic. There were very few intraoperative complications like bleeding from appendicular artery and spillage from appendix in one patient who underwent OA. Mean duration of surgery was 65.18 minutes (SPLA>CLA>OA). Surgery took less time in patients with BMI<25 (SPLA>CLA>OA). CLA took substantially less time (49.5 minutes) in patients with BMI=25 (CLA>OA>SPLA). Pain was significantly higher in minimal invasive procedures compared to OA in immediate postoperative period, which settled 4th hour onwards and remained on higher side for patients who underwent OA. Three fourth patients were able to accept orally after six hours. Wound infection rate was low (OA>CLA=SPLA). Patients who underwent OA stayed in hospital for a longer time and resumed their duty much later compared to minimal invasive arm. Scar assessment score and overall satisfaction were not much different among the patients with simple appendicitis of three arms. Cost of treatment was significantly higher for SPLA compared to other treatment arms.
Conclusion: In patients with simple uncomplicated appendicitis, OA, CLA and SPLA do not differ much in outcome especially in lean and thin patients.