Appendectomy Open Versus Laparoscopic in Developing World Scenario

Authors

  • Saif Ud Din Awan South Qunfudhah Gen Kospital, Kingdom of Saudi Arabia
  • Ayesha Naureen Awan Ayub Medical College Abbottabad, Pakistan
  • Nadia Haleem Ayub Medical College, Abbottabad, Pakistan
  • Hina Fayyaz Women Medical College, Abbottabad, Pakistan

DOI:

https://doi.org/10.52206/jsmc.2024.14.2.782

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,

References

Addiss DG, Shaffer N, Foweler BS, Tauxe R. The epidemiology of appendicitis and appendicectomy in the United States. Am J Epidemiology 1990;132:91025. DOI: https://doi.org/10.1093/oxfordjournals.aje.a115734

Lin Yang, Rongshou Zheng, Hong Li, Yan Ren, Hui Chen. The burden of appendicitis and surgical site infection of appendectomy worldwide. J Infect Dev Ctries 2023 Mar 31;17(3):367-373. DOI: https://doi.org/10.3855/jidc.17145

Wickramasinghe DP, Xavier C, Samarasekera DN. The Worldwide Epidemiology of Acute Appendicitis: An Analysis of the Global Health Data Exchange Dataset. World J Surg 2021 Jul;45(7):1999-2008. DOI: https://doi.org/10.1007/s00268-021-06077-5

Chen QY, Zhong Q, Liu ZY, Huang XB, Que SJ, Zheng WZ. Advances in laparoscopic surgery for the treatment of advanced gastric cancer in China. Eur J Surg Oncol 2020 Oct;46(10 Pt B):e7-e13. DOI: https://doi.org/10.1016/j.ejso.2020.07.015

Portenkirchner C, Turina M, Rickenbacher A. Single incision laparoscopic surgery (SILS) versus conventional laparoscopic technique for ileostomy: a retrospective cohort study. Langenbecks Arch Surg 2022 Jun;407(4):1757-1763. DOI: https://doi.org/10.1007/s00423-022-02473-0

Beltzer C, Bachmann R, Strohäker J, Axt S, Schmidt R, Küper M, etal. Wertigkeit der Laparoskopie beim penetrierenden und stumpfen Abdominaltrauma ein systematisches Review [Value of laparoscopy in blunt and penetrating abdominal trauma-a systematic review]. Chirurg 2020 Jul;91(7):567-575. DOI: https://doi.org/10.1007/s00104-020-01158-y

Pau L, Navez J, Cawich SO, Dapri G. Laparoscopic Management of Blunt and Penetrating Abdominal Trauma: A Single-Center Experience and Review of the Literature. J Laparoendosc Adv Surg Tech A 2021 Nov;31(11):1262-1268. DOI: https://doi.org/10.1089/lap.2020.0552

Romeo L, Bagolini F, Ferro S, Chiozza M, Marino S, Resta G, et al. Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives. Surg Today 2021 Jul;51(7):1075-1084. DOI: https://doi.org/10.1007/s00595-020-02177-2

Yamamoto R, Cestero RF, Kameyama N, Sasaki J. Characteristics of Laparoscopic Surgery for Trauma Patients and Risks of Conversion to Open Laparotomy. World J Surg 2022 Nov;46(11):2616-2624. DOI: https://doi.org/10.1007/s00268-022-06714-7

Jung-Min Bae, Chang-Yeon Jung, Keesang Yoo, Hak-Jae Lee, Suk-Kyung Hong, Sungyeon Yoo. Current status of laparoscopic emergency surgery in Korea: multicenter restrospective cohort study. J Minim Invasive Surg 2023 Sep 15;26(3):112-120. DOI: https://doi.org/10.7602/jmis.2023.26.3.112

Agresta F, Arezzo A, Allaix ME, Arolfo S, Anania G. Current status of laparoscopic colorectal surgery in the emergency setting. Updates Surg 2016 Mar;68(1):47-52. DOI: https://doi.org/10.1007/s13304-016-0356-1

Carpio Colmenares YT, Cárdenas Ruiz de Castilla D, García Barrionuevo LA, Li Valencia MR, Mansilla Doria P, Martinez Nole V, et al. Emergency Abdominal Laparoscopic Surgery During the Coronavirus Disease 2019 Pandemic: Experience in a Private Center in Peru. J Laparoendosc Adv Surg Tech A 2021 Mar;31(3):261-265. DOI: https://doi.org/10.1089/lap.2020.0917

Becker F, Morgül H, Katou S, Juratli M, Hölzen JP, Pascher A. Robotic Liver Surgery - Current Standards and Future Perspectives. Z Gastroenterol 2021 Jan;59(1):56-62. English. DOI: https://doi.org/10.1055/a-1329-3067

Chen Y, Fan Z, Zhang X, Fu X, Li J, Yuan J, et al. A brief overview of single-port laparoscopic appendectomy as an optimal surgical procedure for patients with acute appendicitis: still a long way to go. J Int Med Res 2023 Jul; 51(7):03000605231183781 DOI: https://doi.org/10.1177/03000605231183781

Garbutt JM, Soper NJ, Shannon W, Botero A, Littenberg B. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc 1999;9:1726. PMID:9950122. https://www.ncbi. nlm.nih.gov/books/NBK67973/

Mán E, Szilágyi A, Simonka Z, Rárosi F, Petõ Z, et al. Validation of the modified Alvarado score on patients attending A&E units with suspected appendicitis. BMC Emerg Med 2023;23:87. DOI: https://doi.org/10.1186/s12873-023-00846-2

McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. American Journal of Emergency Medicine 2007;25(5):489-93. DOI: https://doi.org/10.1016/j.ajem.2006.08.020

Pedro de J Wagner, Haroon M, Morarasu S, Eguare E, Al-Sahaf O. Does CT Reduce the Rate of Negative Laparoscopies for Acute Appendicitis? A Single-Center Retrospective Study; J Med Life 2020 Jan-Mar; 13(1): 26-31. DOI: https://doi.org/10.25122/jml-2019-0099

Kovi E. Bessoff, Choi J, Christopher J. Wolff, Kashikar A, Garrison M. Carlos, Caddell L, et al. Evidence-based surgery for laparoscopic appendectomy: A stepwise systematic review; Surg Open Sci 2021 Oct;6:29-39. Published online 2021 Aug 26. DOI: https://doi.org/10.1016/j.sopen.2021.08.001

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213. DOI: https://doi.org/10.1097/01.sla.0000133083.54934ae

Andrea T. Fisher, Kovi E. Bessoff, Rida I. Khan, Gavin C. Touponse, Maggie M.K. Yu, Advait A. Patil, et al. Evidence-based surgery for laparoscopic cholecystectomy; Surg Open Sci 2022 Oct; 10: 116-134. DOI: https://doi.org/10.1016/j.sopen.2022.08.003

Fujita N, Yasuda I, Endo I, Isayama H, Iwashita T, Ueki T, et al. Evidence-based clinical practice guidelines for cholelithiasis 2021; J Gastroenterol 2023;58(9):801-833. DOI: https://doi.org/10.1007/s00535-023-02014-6

Sugiura K, Suzuki K, Umeyama T, Omagari K, Hashimoto T, Tamura A. Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis; BMC Health Serv Res 2020;20:10-19. DOI: https://doi.org/10.1186/s12913-020-05839-6

Basukala S, Thapa N, Bhusal U, Shrestha O, Karki S, Regmi SK, Shah KB, Shah A. Comparison of outcomes of open and laparoscopic appendectomy: A retrospective cohort study.; Health Sci Rep. 2023 Aug 3;6(8):e1483. DOI: https://doi.org/10.1002/hsr2.1483

Bludevich BM, Danielson PD, Snyder CW, Nguyen ATH, Chandler NM; Does speed matter? A look at NSQIP-P outcomes based on operative time. J Pediatr Surg 2021 Jun;56(6):1107-1113. DOI: https://doi.org/10.1016/j.jpedsurg.2021.02.033

Tarnoff M. A Comparison of Laparoscopic and Open Appendectomy, JSLS 1998;2:153-158. PMID: 9876729. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015275/

Thane Blinman. Incisions do not simply sum. Surgical Endoscopy 2010;24:1746-1751. DOI: https://doi.org/10.1007/s00464-009-0854-z

Kovler ML, Pedroso FE, Etchill EW, Vacek J, Bouchard ME, Many BT, et al. Prolonged In-hospital Time to Appendectomy is Associated with Increased Complicated Appendicitis in Children. Ann Surg 2022 Jun 1;275(6):1200-1205. DOI: https://doi.org/10.1097/SLA.0000000000004316

Kouhia ST, Heiskanen JT, Huttunen R, Ahtola HI, Kiviniemi VV, Hakala T. Long-term follow-up of a randomized clinical trial of open versus laparoscopic appendicectomy. Br J Surg 2010; 97:1395-1400. DOI: https://doi.org/10.1002/bjs.7114

Swank HA, Eshuis EJ, van Berge Henegouwen MI, Bemelman WA. Short- and long-term results of open versus laparoscopic appendectomy. World J Surg 2011;35:1221126; discussion 1221-126. DOI: https://doi.org/10.1007/s00268-011-1088-5

Kapischke M, Friedrich F, Hedderich J, Schulz T, Caliebe A. Laparoscopic versus open appendectomy--quality of life 7 years after surgery. Langenbecks Arch Surg 2011;396:69-75. DOI: https://doi.org/10.1007/s00423-010-0715-1

Moore DE, Speroff T, Grogan E, Poulose B, Holzman MD. Cost perspectives of laparoscopic and open appendectomy. Surg Endosc 2005;19:374-8. DOI: https://doi.org/10.1007/s00464-004-8724-1

Guevara-Cuellar CA, Rengifo-Mosquera MP, Parody-Rúa; Cost-effectiveness analysis of nonoperative management versus open and laparoscopic surgery for uncomplicated acute appendicitis in Colombia. E.Cost Eff Resour Alloc 2021 Jun 10;19(1):34. DOI: https://doi.org/10.1186/s12962-021-00288-2

United nations Population Fund, https://www.unfpa.org/data/world-population/PK

Pakistan Labour Force Survey 2020-21 (Annual Report), published by Government of Pakistan Ministry of Planning, Development and Special Initiatives, Pakistan Bureau of statistics (2022).

Global Data Lab, Institute for Management Research, Radboud University, Netherlands published on their https://globaldatalab.org/areadata/table/hhsize/PAK

Pakistan Among World's Top Generous Nations. Mohammed Arifeen. Pakistan and Gulf Economist June 11, 2018 Updated:June 11, 2018

Additional Files

Published

21-04-2024

How to Cite

1.
Saif Ud Din Awan, Ayesha Naureen Awan, Nadia Haleem, Hina Fayyaz. Appendectomy Open Versus Laparoscopic in Developing World Scenario. J Saidu Med Coll Swat [Internet]. 2024 Apr. 21 [cited 2024 Jun. 13];14(2):84-92. Available from: https://jsmc.pk/index.php/jsmc/article/view/782