Open versus laparoscopic appendicectomy in acute appendicitis: results of a district general hospital

Background:Despite multiple studies comparing the two methods, the real advantages of laparoscopic appendicectomy (LA) compared to open appendicectomy (OA) are still unclear. Purpose of the current study was to compare the results between the two techniques in a district general hospital.Methods:The electronic records of all patients who underwent OA or LA in a one year period were reviewed retrospectively. The comparative data points assessed included age, gender, overall complications, length of stay and Clavien-Dindo Classification of Surgical Complications, including the rates of the main types of complications. Results:300 patients were included in the study. 166 patients underwent OA and 134 patients LA. Postoperative complications were documented in 26 patients (8.7%). LA was employed predominantly in female patients (p = 0.004) and in older patients (p = 0.0015) and was associated with significantly more negative appendicectomies than OA (p = 0.002). No statistically significant difference was noted with regards to the length of hospital stay (p = 0.577), overall postoperative morbidity (p = 0.543) and grading of complications (p = 0.460). Finally, following comparison of the incidence of specific types of complications, only wound infections were significantly different, in favour of LA.Conclusions:LA is safe and effective, however, besides the lower incidence of wound sepsis, demonstrates no clear advantage over OA. The selection between OA and LA should thus be tailored to the clinical scenario and the surgeon's preference

The Effects of Lateral Wedge Insole in the Management of Patients with Varus Osteoarthritis of the Knee

Although insufficient evidence supports the application of lateral wedge insole (LWI) as a non-operative treatment for medial/varus osteoarthritis of the knee joint; objective evaluation of its effects on pain; stiffness and functional disability is limited. The purpose of the study therefore was to determine the effect of LWI on the functional disability and symptoms resulting from the medial/varus osteoarthritis of the knee.Fifty (50) out of 76 patients referred for physiotherapy with diagnosis of varus osteoarthritis of the knee joint participated in this study. The 50 subjects were randomly assigned into 2 groups of 25 patients each. Group A (Experimental); were treated with thermal therapy; massage and LWI. Group B (Control); were treated with thermal therapy and massage only. The outcome measures included knee pain; knee stiffness and functional disability. These parameters were statistically analysed pre and post treatment.Results established a significant difference (p0.05) post treatment between the 2 groups for the outcome measures except knee stiffness. It can be inferred from the results that the therapeutic reduction in pain intensity and enhanced physical activities in group A compared with group B was induced by the LWI.These results provide some insight into the functional effects of the LWI on pain; knee stiffness and functional disability of patients with medial osteoarthritis of the knee. This makes the LWI a useful treatment modality in the management of varus osteoarthritis/varum gonarthrosis