Laparoscopic versus open appendicectomy-a comparative study of clinical outcomes in an institutional centre

Background: Appendicectomy remains to be one of the most common procedures performed by the general surgeon. Laparoscopic appendicectomy is likely to have less postoperative pain, less use of analgesics, early discharge, decreased wound infection, better cosmetics and also diagnostic and early return to routine work. Method: This is a comparative study of 50 cases of appendicitis divided equally into two groups 25 in open and 25 in the laparoscopic which were randomly selected and operated in the department of general surgery at PMCH, Patna. Results: In present study pain score was 2.97±0.7 for open group as compared to 1.56±0.7 in lap group (p<0.05) because of longer incision stretch of muscles and wound infection. Post operative complications like vomiting was lower in laparoscopic group with 12% as compared with 40% in open group (p<0.05) and ileus was lower in lap group with 27±4.6 and for open group 31±5.4 with p<0.05 which were significant. There is significant reduction in incidence of post operative wound infection in lap group 0% as compared to open group 32% (p<0.05). Duration of postoperative hospital stay was significantly low for lap group 2±0.78 as compared to open group 8±0.89. The return to normal activity was low for lap group 14±2.11 days as compared to open group 21.7±3.7days. Duration of surgery for open appendicectomy was 48±19 mins and for lap appendicectomy was 46±15 mins. Conclusions: Overall laparoscopic appendicectomy is better than open appendectomy in selected patients with acute or recurrent appendicitis.

Laparoscopic versus open appendicectomy-a comparative study of clinical outcomes in an institutional centre

Background: Appendicectomy remains to be one of the most common procedures performed by the general surgeon. Laparoscopic appendicectomy is likely to have less postoperative pain, less use of analgesics, early discharge, decreased wound infection, better cosmetics and also diagnostic and early return to routine work. Method: This is a comparative study of 50 cases of appendicitis divided equally into two groups 25 in open and 25 in the laparoscopic which were randomly selected and operated in the department of general surgery at PMCH, Patna. Results: In present study pain score was 2.97±0.7 for open group as compared to 1.56±0.7 in lap group (p<0.05) because of longer incision stretch of muscles and wound infection. Post operative complications like vomiting was lower in laparoscopic group with 12% as compared with 40% in open group (p<0.05) and ileus was lower in lap group with 27±4.6 and for open group 31±5.4 with p<0.05 which were significant. There is significant reduction in incidence of post operative wound infection in lap group 0% as compared to open group 32% (p<0.05). Duration of postoperative hospital stay was significantly low for lap group 2±0.78 as compared to open group 8±0.89. The return to normal activity was low for lap group 14±2.11 days as compared to open group 21.7±3.7days. Duration of surgery for open appendicectomy was 48±19 mins and for lap appendicectomy was 46±15 mins. Conclusions: Overall laparoscopic appendicectomy is better than open appendectomy in selected patients with acute or recurrent appendicitis.

A Rare Case of Posterior Ischemic Optic Neuropathy after Appendicectomy

Ischemic optic neuropathy is classified into anterior and posterior ischemic optic neuropathy depending upon the part of optic nerve involved. In anterior optic neuropathy, optic nerve head is involved and in posterior ischemic optic neuropathy(PION) retrobulbar portion is involved. There is sudden loss of vision in both the entities but there are optic disc changes in anterior optic neuropathy while in posterior ischemic optic neuropathy optic disc is normal initially. Etiologically, posterior ischemic optic neuropathy is divided into non arteritic non-surgical, arteritic and perioperative non arteritic posterior ischemic optic neuropathy.

Mucocele apendicular benigno / Benign Appendiceal Mucocele

Introducción: El mucocele apendicular se considera una lesión rara del apéndice que se caracteriza por la dilatación de la luz del órgano con acumulación de moco. Este puede ser benigno o maligno. Objetivo: Caracterizar un caso de mucocele apendicular de comportamiento benigno en un paciente adulto masculino. Presentación del caso: Se asiste a un paciente, en estudio de tumor de vías digestivas, que se interviene quirúrgicamente con cuadro peritoneal agudo hallando masa de localización apendicular. Se realiza apendicectomía convencional y se estudia la pieza por anatomía patológica como mucocele apendicular benigno. La evolución del paciente fue satisfactoria. Conclusiones: Se presenta clínicamente de forma inespecífica, lo que posibilita que su diagnóstico sea intraoperatorio con mayor frecuencia. La estrategia quirúrgica depende de los hallazgos intraoperatorios donde la apendicectomía y la hemicolectomía derecha son las técnicas más utilizadas. El pseudomixoma peritoneal es una complicación temida(AU)

Introduction: Appendiceal mucocele is considered a rare lesion of the appendix characterized by dilatation of the organ lumen with mucus accumulation. It can be benign or malignant. Objective: To characterize a case of appendiceal mucocele with benign behavior in an adult male patient. Case presentation: A patient under study of digestive tract tumor is attended. The patient underwent surgery for having acute peritoneal symptoms; a mass of appendicular location was found. Conventional appendicectomy was performed and the piece was studied by pathological anatomy, being a benign appendicular mucocele. The patient's evolution was satisfactory. Conclusions: This condition is presented clinically in a nonspecific manner, which makes for its diagnosis to be more frequently intraoperative. The surgical strategy depends on the intraoperative findings, in which appendectomy and right hemicolectomy are the most used techniques. Pseudomyxoma peritonei is a feared complication(AU)

Evaluation of efficacy of pregabalin as premedication for post-operative analgesia in open appendicectomy

Background: Pregabalin is gamma amino butyric acid (GABA) structural analogue, effectively used in management of different neuropathic pain, incisional and inflammatory injuries. Current study aimed to evaluate the efficacy of pregabalin 75 mg with a placebo as premedication for post-operative analgesia in patients posted for open Appendicectomy under regional anesthesia. Methods: A randomized controlled trial was conducted on 90 patients undergoing open Appendicectomy under regional anesthesia. The patients were divided in two groups of 45 each: group C (placebo); group P (75 mg pregabalin), drug was administered orally 60 minutes before surgery. The Ramsay sedation scale (RSS) was used for assessment of sedation and the visual analog scale (VAS) was used to determine pain at rest and cough, along with assessment of time required for rescue analgesics on the first post-operative day. Results: The RSS scores were significantly higher in groups P as compared to the controls (p<0.001). Postoperative VAS scores for pain both at rest and on cough were significantly reduced in group P (p<0.001). Rescue analgesic consumption decreased significantly in group P (p<0.001). The time at which first dose of rescue analgesia administered was 4.50±3.04 hours in group C, 10.90±5.37 hours in group P (p<0.001). Conclusions: Pregabalin as premedication prolong the postoperative analgesia in addition to decreased consumption of analgesics.

Tratamiento quirúrgico de la apendicitis aguda durante la pandemia: el daño colateral del COVID-19 / Surgical treatment of acute appendicitis in pandemic: COVID -19 collateral damage

RESUMEN Antecedentes: la pandemia por COVID-19 generó cambios en el manejo de pacientes con todo tipo de patologías. Mostramos la experiencia respecto de los pacientes con apendicitis aguda (AA) operados en un hospital universitario de la Ciudad Autónoma de Buenos Aires durante los meses de confina miento y su comparación con el mismo período del año 2019 a fin de evaluar las diferencias. Material y métodos: se analizó en forma retrospectiva una base confeccionada de forma prospectiva. Se compararon pacientes operados de AA, consignando los datos respecto del período preoperatorio, comparando datos inherentes a la cirugía y sus resultados en los períodos marzo-julio de 2019 y 2020. Resultados: fueron incluidos 127 pacientes, 46 de ellos operados durante la pandemia. Los pacientes operados durante la pandemia presentaron mayor incidencia de peritonitis (61,7% vs. 76,1%; p: 0,09) y mayor requerimiento de drenaje abdominal (9,9% vs. 23,9%; p: 0,03). También tuvieron mayor in cidencia de complicaciones (10,9 vs. 4,9%; p: 0,21), reoperaciones (8,7 vs. 1,23%, p: 0,03), reinterna ciones (6,5 vs. 0%, p: 0,02) y requerimiento de antibioticoterapia endovenosa prolongada (6,5 vs. 0%; p: 0,02). La estadía hospitalaria fue mayor para la cohorte operada durante la pandemia: 3,24 días (Desvío estándar [D.E.]: 7,31) vs. 1,89 días (D.E: 2,04). Conclusiones: durante la pandemia por COVID-19, el número de pacientes operados por AA disminuyó con respecto al año 2019; se observaron estadios más avanzados de la enfermedad, mayores compli caciones en el posoperatorio y mayor estadía hospitalaria.

ABSTRACT Background: COVID-19 pandemic has generated changes regarding the management of patients with all kind of pathologies. Here we show the experience concerning the surgical treatment of acute appendicitis (AA) in a teaching hospital in the city of Buenos Aires during the lockdown, and its comparison with the same period of 2019 in order to assess the differences between the timing for consultation, intraoperative findings and the treatment outcome. Material and methods: A prospective database was retrospectively analyzed. We compared patients undergoing surgical treatment for AA in March-July of 2019 v. March-July 2020, taking into account the preoperative period and comparing the outcome regarding the surgical intervention and the impact in the postoperative period between the two groups. Results: 127 patients were included, 46 treated during the pandemic. Patients undergoing surgical treatment during the pandemic had a higher incidence of peritonitis (61.7% vs. 76.1%; p = 0.09) and higher requirement of abdominal drainage (9.9% vs. 23.9%; p = 0.03). There was an increase in the incidence of complications (10.9 vs. 4.9%; p: 0.21), reoperations (8.7 vs. 1.23%, p: 0.03), readmissions (6.5 vs. 0%, p: 0.02) and need for out-patient intravenous antibiotics (6.5 vs. 0%; p: 0.02). The average hospital length was of 1.89 (SD 2.04) and 3.24 (SD 7.31) for the groups operated before and during pandemic, respectively. Conclusions: During the COVID-19 pandemic, the number of patients undergoing surgical intervention because of AA decreased compared to the previous year, with increased complications in the postoperative period, higher compromise of the appendix, and longer hospital stay.

Appendectomy: prognostic factors in the brazilian unified health system

SUMMARY INTRODUCTION: Acute appendicitis (AA) is the most common cause of surgical acute abdomen. Postoperative complications in emergency care are reflections of the surgical procedure and pre- and postoperative factors. OBJECTIVE: Define prognostic factors for patients who underwent appendectomy, comparing them with the literature. METHODS: Descriptive observational study with a cross-sectional design based on data from the emergency/urgency appendectomy records between September 2018 and April 2019. Variables of interest were considered based on intrinsic patient data, clinical status, and perioperative management factors. Primary outcomes considered: postoperative complications from hospital admission discharge and prolonged hospital stay for > 2 days. Secondary outcome: death. The results were evaluated by Fisher's exact test (p <0.05). RESULTS: We identified 48 patients undergoing an appendectomy. Young adults accounted for 68.7%. From the total, 58.3% were males, 6 (12.5%) had hospitalization> 2 days, 4 (8.3%) had complications and no deaths. Among the variables, the stage of AA, the time of complaint up until seeking care, and advanced age were correlated with worse prognosis during hospitalization (p <0.05). The emergence of immediate postoperative complications was correlated with longer hospital stay (p <0.05). DISCUSSION: The descriptive data of the sample converge with the epidemiological profile of patients with AA in the literature, corroborating the applicability of conventional guidelines. The results strengthen the hypothesis that the patient's flow with abdominal manifestations is complicated from the first contact with SUS to the resolution of the condition. CONCLUSION: Knowledge of the epidemiological profile and perioperative predictors that are most related to complications favor the appropriate management of patients.

RESUMO INTRODUÇÃO: Apendicite aguda (AA) é causa mais comum de abdome agudo cirúrgico. Complicações pós-operatórias na emergência são reflexos do ato cirúrgico e fatores pré e pós-operatórios. OBJETIVO: Definir fatores prognósticos para paciente pós apendicectomia, comparando com a literatura. MÉTODOS: Estudo observacional descritivo e analítico com formação de base transversal de dados dos prontuários de apendicectomias de emergência/urgência entre setembro de 2018 e abril de 2019. Variáveis de interesse foram consideradas a partir dos dados intrínsecos ao paciente, quadro clínico e manejo perioperatório. Desfechos primários combinados considerados foram complicações pós-operatórias da internação até alta hospitalar e prolongamento da internação > dois dias. Desfecho secundário foi óbito. Resultados avaliados pelo teste exato de Fisher (p<0,05). RESULTADOS: Identificaram-se 48 pacientes submetidos à apendicectomia. Adultos jovens corresponderam a 68,7%. Do total, sexo masculino (58,3%), seis (12,5%) tiveram internação > dois dias, quatro (8,3%) cursaram com complicação e nenhum óbito. Dentre as variáveis consideradas, fase de apresentação da AA tempo de queixa até procura do atendimento e idade avançada correlacionaram com pior prognóstico durante internação (p<0,05). Surgimento de complicações pós-operatórias imediatas correlacionou-se com maior tempo de internação (p<0,05). DISCUSSÃO: Dados descritivos da amostra convergem com perfil epidemiológico de pacientes com AA na literatura, corroborando aplicabilidade das diretrizes convencionais. Resultados fortalecem a hipótese de que o fluxo do paciente com manifestações abdominais é complicado desde o primo-contato com o SUS até a resolução do quadro. CONCLUSÃO: Conhecimento do perfil epidemiológico e dos preditores perioperatórios que mais se relacionam com complicações favorecem manejo adequado dos pacientes.

Role of laparoscopic appendicectomy in management of early appendicular mass

Background: Appendicular mass consists of matted loops of bowel and omentum adherent to the adjacent inflamed appendix. Laparoscopic approach adds diagnostic value and allows visualization of entire abdominal viscera facilitating better and safer dissection.Methods: This is an observational prospective study done in patients presenting to Gandhi Hospital’s surgical department with incidentally detected appendicular mass on laparoscopy from August 2016 to August 2018.Results: Maximum cases belong to adolescent age group (13 out of 30). Majority of cases are male patients (24 out of 30). Each surgery took around 1 hour. No intraoperative complications occurred in 23 patients. Difficult adhesiolysis experienced in 5 patients. Serosal bowel injury occurred in 1 patient. Orals were delayed where intraoperative dissection was prolonged or difficult. Majority of patients were discharged after 3 days.Conclusions: With immediate operative management of appendicular mass presenting in early stages of inflammation, dissection can be safely proceeded with and appendicectomy can be safely performed eliminating the need for second hospitalization and risk of recurrence. The incidence of intra-operative and post-operative complications is low making laparoscopic appendicectomy in early appendicular mass a safe and feasible treatment option.

Is it safe to perform laparoscopic appendicectomy in a low volume rural setting? A retrospective non-comparative study

Background: Inspite of the rapid adoption of laparoscopy as a technology for surgeries of the abdomen, its use is very limited in rural settings with limited resources in India. This study was carried out to find out whether performing laparoscopic appendicectomies (which is the commonest general surgery performed the world over) in a low volume rural hospital is feasible, safe and should it be the recommended procedure of choice. Also, the pattern of demographics, symptoms, signs, investigation reports of the patients who presented with acute appendicitis at the centre was studied.Methods: Retrospective analysis of the data from electronic medical records in Bodeli General Hospital from March 2015 to February 2020 was done. Data of all laparoscopic appendicectomies performed (108 in numbers) in this rural centre with low volume work and a single surgeon, was analysed.Results: Various cost-cutting local innovations were used, the age and sex distribution, presenting complaints, examination findings, investigation reports, operative time and complications were analysed and presented.Conclusions: It is quite evident that performing laparoscopic appendicectomies in low volume, single surgeon setting is a safe procedure and should be the procedure of choice, whenever an appendicectomy is indicated.

Clinico- Epidemiological Profile of Acute Appendicitis in a Tertiary Care Hospital in North India

Introduction: Acute appendicitis is one of the most commonsurgical emergencies. Accurate diagnosis of acute appendicitisneeds careful history, and physical evaluation, as the diagnosisis primarily clinical.Material and methods: A cross sectional study was done in50 patients who underwent emergency appendicectomy foracute appendicitis in a medical college hospital in Shimla.The aim was to study the clinical profile of patients with acuteappendicitis and compare it with the existing literature.Results: Mean age of patients was 26.48 (± 12.28) years.Out of 50 patients, 29 (58%) were males and 21 (42%) werefemales, so male predominance was seen in the present study.Most common complaints were pain in the right iliac fossa(100%), nausea and vomiting (82%), anorexia (80%), andmigration of pain (70%). Tenderness in right iliac fossa waspresent in all patients in our study (100%), while reboundtenderness (70%), guarding (64%), rigidity (6%), Rovsingsign (36%), Psoas sign (46%), Obturator sign (22%), andDunphy sign (60%), respectively.Conclusions: Acute appendicitis is more common amongmales than females, and between 10- 30 yrs of age. Themost common presenting features were pain abdomen,anorexia, nausea, and vomiting. The most common signs weretenderness, rebound tenderness and guarding. The rate ofaccuracy of clinical examination was 86%.

Laparoscopic versus open appendicectomy: a non-randomized comparative study

Background: Appendicectomy is one of the most common surgical procedures performed in emergency surgery. Despite this, there is still lack of consensus about the most appropriate technique for appendicectomy. In this longitudinal analysis, we aimed to compare the outcomes of laparoscopic appendicectomy (LA) and the conventional technique or open appendicectomy (OA) in the treatment of acute appendicitis.Methods: A non-randomized longitudinal comparative study was conducted in NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India. From November 2017 to October 2019, 53 patients underwent OA and 59 underwent LA, making a total number of patients included in this study to be 112 (n). The two groups were compared for operative time, length of hospital stay, postoperative pain, post-operative ileus and complication rate.Results: Laparoscopic appendicectomy was associated with a shorter hospital stay (4.34±1.37 days in LA and 5.09±1.71 days in OA, p<0.01), with a lower post operative pain score [VAS] (2.93±0.80 in LA and 4.62±0.92 in OA, p<0.001). Operative time was shorter in the open group (42.70±12.05 min in OA and 43.39±16.59 in LA). Complications were lesser in the LA group with a significantly lower incidence of wound infection (3.4% in LA and 13.2% in OA).Conclusions: Laparoscopic approach is safe and efficient in appendicectomy and it provides clinically advantages over open method (shorter hospital stays, lower post op pain, early food tolerance, earlier return to work and lesser wound infection) against only marginally longer operative time.

Stump appendicitis single centre experience: a retrospective study

Background: Appendicectomy is the most common surgical procedure done for acute appendicitis worldwide. However, one among 50000 appendicectomy patients may present with recurrent abdominal pain, requiring hospitalization as stump appendicitis and may need completion appendicectomy. There are a few reports addressing management of stump appendicitis in the literature. Here we present our experience of laparoscopic completion appendicectomy over ten-year duration.Methods: A retrospective evaluation of records of appendicectomy from January 2008 to December 2018. All patients who had stump appendicitis as diagnosis and those who underwent completion appendicectomy were included. There were no exclusions. Details pertaining to presentation, duration of symptoms, records of previous surgery, perioperative and postoperative data was recorded, including follow-up of at least six months.Results: All 15 patients were managed by laparoscopic completion appendicectomy. Patients age range from 12 to 58 years, 12 were males and 3 female, duration of symptoms was from two to ten days, previous appendicectomy was done 4 to 84 months before, nine were diagnosed by ultrasonography of abdomen and six by CT scan, stump size ranged from 1 to 3.6 cm, mean operating time was 86.4 mins (range, 60-120 minutes). Duration of hospital stay was 3 to 5 days. There were no perioperative morbidity or mortality.Conclusions: Laparoscopic approach of completion appendicectomy is safe for management of stump appendicitis.

Open versus laparoscopic appendicectomy: a prospective comparative study

Background: Open appendectomy has been the gold standard for the treatment of acute appendicitis since its introduction by Charles Mc Burney in 1889.The introduction of laparoscopic surgery has dramatically changed the field of surgery. Various studies showed conflicting results about the superiority of laparoscopic approach over open for treatment of acute appendicitis. Present study is conducted to determine any possible benefits of the laparoscopic approach over open surgery.Methods: The study was conducted in Dr. V. M. Government Medical College and hospital located in Solapur (Maharashtra) from September 2017 to September 2019. It is a prospective comparative study. Patients were randomly divided into 2 groups alternately where group A and B were operated by conventional and laparoscopic techniques respectively and their outcomes were compared.Results: Mean age of patients in open and laparoscopic appendicectomy group was 29.67 years and 31 years respectively. Post-operative pain, wound infection and hospital stay was significantly more in open group as compared to laparoscopic group (p<0.05).Conclusions: From the results of our study we conclude that laparoscopic appendicectomy has superior results as compared to open appendicectomy.

A Study to Evaluate the Combined Use of Alvarado Score and Imaging for Diagnosis of Acute Appendicitis.

Acute appendicitis is one of the most common abdominal emergencies encountered in surgical practice. The diagnosis of acute appendicitis is an enigmatic challenge. Several studies have reported a variable diagnostic accuracy with a negative appendicectomy rate varying from 3% up to 20% using combined diagnostic modalities or using Alvarado score alone. The present study was carried out to evaluate the diagnostic efficacy of combined use of Alvarado score and imaging modalities (USG and / or CECT abdomen) for preoperative diagnosis of acute appendicitis.METHODSThe present study was a prospective observational study carried out in a tertiary hospital of a metropolitan city. The study period extended over two years, from January 2016 till December 2018. The study included 118 adults who presented with clinical features of acute appendicitis. Alvarado scoring system based mainly on clinical features was applied and graded. Compression USG was performed on all patients. CECT of abdomen was done in 30 patients having inconclusive results on USG. Appendicectomy was performed on all the patients after the Alvarado scoring and imaging. The histopathological findings of the surgical specimens were noted to confirm the pathological diagnosis. The sensitivity, specificity, PPV, NPV and accuracy of the diagnostic methods were calculated.RESULTSOut of 118 appendicectomies, 104 were found to be positive on histopathology, with an overall 11.86% negative appendicectomy rate. Combined use of imaging with a high Alvarado score (7-10) had a sensitivity of 95.74%, specificity of 100%, accuracy of 95.8%. Combined use of imaging with a low Alvarado score (3-6) had a sensitivity of 89.47%, specificity of 53.8%, accuracy of 82.85%. Alvarado score alone had a sensitivity of 45.19%, specificity of 92.85% and accuracy of 50.8%. USG alone showed a sensitivity of 71.15%, specificity of 71.42% and accuracy of 71.18%. CECT alone had a sensitivity of 88%, specificity of 60% and accuracy of 83.3%.CONCLUSIONSImaging modalities have a valuable role in terms of diagnostic accuracy particularly in cases having low Alvarado score. CECT though expensive is preferable to USG. However, the combined methodology of Alvarado scoring, and imaging is a rational approach for accurate diagnosis preventing surgical complications and minimizing negative appendicectomy rate.

A study to evaluate the safety and cost effectiveness of preformed catgut endoloops and polyglactin 910 extracorporeal ligation in the management of appendicular stump closure in laparoscopic appendicectomy

Background: The most essential component of laparoscopic appendectomy is the closure of appendicular stump. Failure of which can result in catastrophic complications including intra-abdominal and surgical site infections and rarely faecal fistula. The aim of this study was to verify the effectiveness of preformed catgut endoloop and extracorporeal polyglactin 910 for appendicular stump closure.Methods: This prospective study was carried out in 64 patients. We compared patient demographics, duration of surgery, intra and post-operative complications, hospital stay and cost of surgery between the two groups.Results: A total of sixty-four patients were finally included in the analysis, catgut group (n=34), polyglactin 910 group (n=30). The demographics between the two groups were similar. The mean age in catgut group was 23.94 years and polyglactin 910 groups was 23.33 years. Mean duration of surgery was 41.6 and 41.8 minutes in catgut and endoloop group respectively. Mean hospital stay was 3 days. There was no mortality but complications were seen in 6 patients. However, there was no statistical significance in between the two groups with any of the parameters studied.Conclusions: Multiple studies have demonstrated safety and effectiveness of various techniques of appendicular stump. The use of extracorporeal single polyglactin 910 extracorporeal suture knot is safe and cost-effective technique for closure of appendicular stump in rural and resource poor regions.

Open Versus Laparoscopic Appendicectomy in a Tertiary Care Center – A Randomized Controlled Study

Introduction: Appendicitis is the most common causeof surgical abdomen in all age groups with a lifetime riskof 6%. The role of laparoscopic appendicectomy remainscontroversial as many researchers have suggested thatoverall morbidity is primarily a function of the degree of theappendicitis rather than the operative approach. The presentstudy was designed to compare the outcome of laparoscopicappendicectomy versus open appendicectomy in a tertiarycare hospital.Material and methods: This was a randomized controlledstudy on 100 cases of acute appendicitis operated inRohilkhand Medical College, Bareilly in a period of one year.The patients were randomly assigned to two groups of 50 eachoperated by open and three port laparoscopic surgery.Results: Abdominal pain (100%) was the commonestpresenting complaint. Retrocaecal anatomical position (76%in open, 70% in lap. appendicectomy) of the appendix wasthe commonest operative finding. Wound infection rate (8%)was insignificantly higher in open appendicectomy. Therewas significantly less operative time, postoperative painbetter cosmesis and early return to normal daily activity inlaparoscopic as compared to open appendicectomy.Conclusion: Laparoscopic appendicectomy is better ascompared to open appendicectomy in terms of post-operativecomplications, post-operative pain, hospital stay, early returnto normal activity, and subjective cosmesis.

External validation of Tzanakis scoring system in acute appendicitis in a rural hospital

Background: Acute appendicitis is one of the most common cause of acute abdomen surgery. Several scoring systems have been adopted by physicians to aid in the diagnosis and decrease the negative appendicectomy rate. Tzanakis scoring system is one such score. Objective of present study was the validation of this scoring system in our population and compare its accuracy with histopathological examination (HPE).Methods: A retrospective study was carried out at the Department of Surgery at Mohammad Afzal Beigh Memorial Hospital Anantnag India. Tzanakis score was calculated in 288 patients who underwent appendicectomy from September 2016-2018 and HPE results were analysed.Results: 276 patients were eligible for the study. The sensitivity and specificity of Tzanakis score in diagnosing appendicitis was 90.66% and 73.68% respectively. The overall diagnostic accuracy was 86.23% with positive predictive value of 97.89% and negative predictive value of 36.84%.Conclusions: Tzanakis scoring system is an accurate modality in establishing the diagnosis of acute appendicitis and preventing a negative laparotomy.

Risk Stratification Using Appendicitis Inflammatory Response Score, A Useful Tool To Reduce Negative Appendicectomy Rate : Our Experience

Background: Acute appendicitis is mostly considered a clinical diagnosis and many surgeons resort to clinical judgement for deciding its management. Such cases often pose a diagnostic dilemma and result in significant negative exploration rates. Appendicitis Inflammatory Response (AIR) score, designed in 2008, is a validated clinical scoring system which has outperformed the well-known Alvarado scoring system. This study evaluates the risk stratification of patients as per AIR scores, correlation with the post-op histopathological examination (HPE) diagnosis to calculate the negative appendicectomy rate and to evaluate the diagnostic performance of this scoring system. Method:This is a prospective observational study carried out between Nov 2016 and May 2018, on 150 cases of acute appendicitis that underwent surgical management. Result: This study data revealed a negative appendicectomy rate of 9.33 %. Statistical analysis showed that scores of 9 - 12 has great accuracy for diagnosis, with a specificity of 100 % and positive predictive value of 1.0 whereas low scores of 0-4 potentially identify cases who do not require surgery. Conclusion:The AIR score is an accurate diagnostic tool when a score of 9 is taken as cut-off. Management algorithms based on AIR score have the potential of reducing negative appendicectomy rate by correct identification of those who don't require surgery.

A study comparing modified Alvarado score and Tzanakis score for diagnosing acute appendicitis

Background: Acute appendicitis is one of the most common causes of Abdominal surgical emergencies with a lifetime prevalence of approximately 1 in 7 worldwide. It is associated with high morbidity and occasional mortality related to the failure of making an early diagnosis. Aim of the study: To compare the efficacy of Modified Alvarado Score and Tzanakis Score in Diagnosing Acute Appendicitis. Materials and methods: The study was conducted in the year 2018. Totally 100 patients between the age of 12 to 75 who presented to the General Surgery department of Govt. Royapettah Hospital with a clinical diagnosis of acute appendicitis and underwent emergency open appendicectomy were included in the study. Both Modified Alvarado Score and Zanakis score were done for all the patients at the time of admission and prior to surgery. Even the patients with scores below the cutoff values were subjected to surgery based on clinical assessment and judgment. Patients were either subjected to emergency laparotomy at the time of admission or after few hours of conservative management. Emergency appendicectomy was done by the open method under spinal or general anesthesia in all cases. Results: The mean age of patients was 22.93 years with a standard deviation of 6.86 years. 83% of patients had histologically proven appendicitis. Overall negative appendicectomy rate was 17%. The sensitivity and specificity of Modified Alvarado Score was 95.81% and 94.11% with a positive predictive value of 98.75% and the negative predictive value of 80%. The positive likely hood ratio was 16.18 and the negative likelihood ratio was 0.05. The sensitivity and specificity of Tzanakis score was 97.59% and 94.11% respectively with a positive predictive value of 98.78% and negative S. Dharmarajan, R. Arvindraj. A study comparing modified Alvarado score and Tzanakis score for diagnosing acute appendicitis. IAIM, 2019; 6(5): 137-141. Page 138 predictive value of 88.88%. The positive likely hood ratio was 16.59 and negative likelihood ratio was 0.03. Conclusion: This study shows that Tzanakis scoring system can be used as an effective modality in the establishment of accuracy in the diagnosis of acute appendicitis. There is increased sensitivity and diagnostic accuracy in Tzanakis scoring when compared to the modified Alvarado score.

A comparative study between laparoscopic and open appendicectomy in KAPV Government Medical College, Trichy

Background: Vermiform appendix, though a vestigial organ in a human without much purpose forms. The most common cause of acute abdomen and also the most common surgical intervention by a general surgeon. Open appendicectomy has been practiced for more than 130 years all over the world with a good outcome. But laparoscopic appendicectomy grabbed the attention of not only surgeons but also the patients after the pioneering efforts of Kurt Semm in 1982. Although our hospital has been practicing open appendicectomy for many decades laparoscopic appendicectomy was introduced in recent past. The aim of the study: Aim was to compare the laparoscopic against open appendicectomy based on the following parameters: Post-surgical pain, Return of bowel sounds, Return to eating, Post-operative complications, Post-operative antibiotics duration. Materials and methods: Patients who come to the outpatient and emergency clinic of the Department of General Surgery, KAPV Government Medical College between January 2016 and June 2017. Among the patients who had come to General Surgery OP clinic and emergency clinic, after thorough examination patients with features of appendicitis were included as subjects for study. Patients were allotted as subjects in each group by simple random sampling. Blood investigation, Chest X-ray, X-ray abdomen, USG abdomen, CT abdomen were done and assessment obtained for Yeganathan Rajappan, Anandan Kanthan, Mahalakshmi Ashok Kumar, Manimaran Thangavelu. A comparative study between laparoscopic and open appendicectomy in KAPV Government Medical College, Trichy. IAIM, 2019; 6(3): 259- 265. Page 260 those patients after sufficient resuscitation with iv fluids, antibiotics, and analgesics. Patients who were diagnosed with appendicitis were explained about the diagnosis, need for surgery, surgical procedure planned and its complications and then informed written consent obtained. Results: In our study, mean operation duration for LA was 61.54 min and 51.62 min for open appendicectomy. The p-value was 0.022 which was significant statistically. Operation duration was short in laparoscopic appendicectomy. Our study also shows less pain for lap group which was calculated using a pain rating scale, with mean in OA as 3.16 and 2.32 in LA group and the p-value was p-0.000 which was statistically significant. Diet was started earlier in lap appendicectomy group in our study. Postoperative complication and postoperative antibiotics duration were less in LA group as like in earlier studies. Conclusion: Laparoscopic appendicectomy is better than open appendectomy in selected patients with acute or recurrent appendicitis.