Laparoscopic Versus Open Appendicectomy – A Randomized Controlled Trial

Background: The authors compare open and laparoscopic appendicectomy in a randomized fashion with an object to define benefit of laparoscopic procedure if any. Methods: Patients of acute appendicitis were randomized to either laparoscopic(n=62) or open (n=58) appendicectomy . Operation time, per-operative findings, concomitant and or other pathological lesions, postoperative pain, rescue narcotic analgesia required, negative appendicectomy rate, hospital stay and complications were noted. Results: No patient in the laparoscopic group required conversion to open. The mean operation time were 36.51±15.81 minutes and 31.62±19.61 minutes for the laparoscopic and open groups respectively (p=0.1368). But the operation time is low in LA group (mean 37.92±16.28 versus 62.55±20.04 minutes, p=.0080) when only high up retrocaecal types were considered. In the laparoscopic group 45 patients (72.58%) had acute appendicitis, 15 (24.19%) had other pathologies (appendix were histologically normal) and in 2(3.225%) appendix were normal. Post operative pain score was significantly low (p=0.037) in LA group after six hours but became insignificant after twelve hours (p=0.959) and twenty fours (p=0.114). The LA group required significantly less rescue narcotic analgesia (p=0.026). Hospital stay was significantly shorter in the laparoscopic group (29.935±8.995 versus 35.413±11.30 hours, p=0.0038). The wound infection rate is higher in open group (13.79% versus 6.45% ) Patients who underwent LA have a shorter operation time in high-up retrocaecal type of appendicitis, significantly less pain and require less rescue narcotic analgesia in comparison to open operation. Conclusions: Laparoscopic method offers an excellent opportunity to detect concomitant other pathology and there by reduce incidence of missdiagnosis and negative appendicectomy rate. The authors consider LA to be the procedure of choice in patients with acute appendicitis.