ABSTRACT
Appendicitis is an acute inflammatory condition of appendix. Since it is a surgical emergency, needs early diagnosis and treatment strategies which include clinical examination, followed by Laboratory investigations and Imaging studies. The scoring systems like Alvarado score have been considered for better diagnosis. In most studies surgery has been reported as the best modality of treatment. Several studies clearly mentioned the impact of various surgical procedures which include Open appendectomy (OA), Conventional laparoscopic appendectomy (CLA) and Single incision laparoscopic appendectomy (SILA). Hence, the present study is carried in an aim to assess and compare the merits and demerits between the surgical procedures Like SILA and CLA. The patients were randomly selected from the surgical department (NMCH) who presented with acute pain abdomen and diagnosed as acute appendicitis. 50 patients were enrolled in the study after fulfilling the inclusion and exclusion criteria. The various demographic variables have been studied between the surgical procedures to demonstrate their impact, which include wound infection rate, pain scores at 24 and 48hrs, the amount of time period for surgery in minutes, patient satisfaction scores and post-operative stay tenure at the hospital in days. The laparoscopic hand instruments used in both techniques are similar, except covidien port which was reused in SILA, following gas sterilization to reduce the cost. Findings reveal that the pain score was significantly lower in SILA than CLA group. The procedure time is comparatively more in SILA than CLA group. Patients had significant satisfaction score in SILA measured at 6 weeks after appendectomy. However the post operative stay, wound infection rate was almost similar in both the groups. There was no conversion to open Appendectomy performed in either of these groups. Results also clearly suggest that the SILA procedure is the safe, alternative and effective technique for the better management of acute appendicitis and seems to be better choice.
ABSTRACT
Acute appendicitis is a surgical emergency, which is associated with morbidity and mortality occasionally. If failed to diagnose early the situation may become more complicated. In acute appendicitis it is not possible to have definitive diagnosis by histopathology preoperatively, we would like a simple test like Alvarado scoring system which depends on the presence and absence of certain variable, which provides an accurate guide to whether or not the patient has the condition. Hence, accurate diagnosis and timely intervention is needed. Therefore, the present study was conducted to evaluate the Alvarado scoring system in diagnosing acute appendicitis and its co relation with histopathology. This prospective study was conducted in 100 consecutive patients admitted in the department of general surgery of Narayana Medical College, Nellore with the clinical diagnosis of acute appendicitis. The findings based on the Alvarado score indicate that 68% of the subjects had a score of more than 7 and 22% of the subjects had a score between 5 and 7. Only 10% of the subjects had a score between 1 and 4. Out of 83 eligible subjects 75 were found to have acute appendicitis by histopathological examination. Negative appendicectomy was very low representing up to 9.6% whereas the percentage of positive predictive value was high representing up to 90.4%. Although the diagnosis of acute appendicitis remains mainly clinical evaluation, the scoring system is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis.