Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 39141

AbstractMaterial and MethodsResultsDiscussionReferencesDOI and Others
Readers' Comments (0) Article in PDF Audio Visual Citation Manager Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1606 - 1609

Laparoscopic versus Open Appendectomy: A Comparison of Primary Outcome Studies from Southern India

B V Goudar, Sunil Telkar , Y.P. Lamani, S.N. SHIRBUR, SHAILESH M.E.

1. Associate Professor, Dept. of Surgery, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India 2. Assistant Professor, Dept. of Surgery, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India 3. Assistant Professor, Dept. of Surgery, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India 4. Professor And Unit Chief, Dept of Surgery, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India. 5. Assistant Professor, Dept. of Surgery, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India

Correspondence Address :
Dr. B V Goudar, Associate Professor, Dept. of Surgery,
SN Medical College and HSK Hospital,
Bagalkot, Karnataka, India-587101,
Phone: +918354-235400.
E-mail-dr.bvgoudar@yahoo.com

Abstract

Introduction
Currently, laparoscopic appendectomy is widely practiced for the management of acute appendicitis. It is not clear whether open or laparoscopic appendectomy is more appropriate. Our aim was to compare the safety and the advantages of laparoscopic versus open appendectomy in a prospective randomized study.
Methods: Two hundred and forty patients were randomly divided into two groups. The group A patients were subjected to laparoscopic appendectomy [LA], whereas the group B patients were subjected to open appendectomy [OA]. The demography and the primary outcome measures of the patients such as operative duration, hospital stay, post-operative pain and post operative complications were recorded and analyzed.
Results:
There were 120 patients in group A and group B each. Of the 120 patients in group A, 6 patients were selected for open appendectomy. The operative time for LA and OA were 18-80 (49)minutes and 30-120 (72) minutes respectively. Although LA was associated with a shorter hospital stay [LA-2.5 days versus OA-4.25 days]; the postoperative complication rates were comparable between the two groups.
Conclusion:
LA is safe and superior to OA with respect to an early discharge, lesser postoperative pain, decreased wound infection, early return to work and a better cosmetic scar.

Keywords

Surgery, Abdomen, LA Versus OA

How to cite this article :

B V Goudar, Sunil Telkar , Y.P. Lamani, S.N. SHIRBUR, SHAILESH M.E.. LAPAROSCOPIC VERSUS OPEN APPENDECTOMY: A COMPARISON OF PRIMARY OUTCOME STUDIES FROM SOUTHERN INDIA. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Sep 15 ]; 5:1606-1609. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1606-1609&id=1772

INTRODUCTION
Acute appendicitis is a common indication for abdominal surgery, with a life-time incidence of between 7 to 9 percent (1), (2). Appendectomy is one of the operations which are most commonly performed by the general surgeons. Open appendectomy has been the gold standard for the treatment of acute appendicitis since its introduction by Charles Mc Burney in 1889 (3). Laparoscopic appendectomy was first performed by Semm in1983 (4). Since then, this procedure has been widely used. In spite of its wide acceptance, there remains a continuing controversy in the literature regarding the most appropriate way of removing the inflamed appendix. Minimal access surgery has been proved to be a useful surgical technique. The application of the recent technology and skills can now provide a better and a cheaper choice of treatment. Despite a lot of randomized trials which have compared laparoscopic and open appendectomy, the indications for laparoscopy in patients with suspected appendicitis remains controversial. The present study was designed to compare the advantages of laparoscopic appendectomy over conventional open appendectomy, with a review of the literature.

Material and Methods

PATIENTS AND METHODS
This prospective study was conducted in the Department of Surgery, SNMC and HSK Hospitals, Bagalkot, from January 2008 to September 2011. Two hundred and forty consecutive patients of the age range of 12-48 years, with features which were suggestive of acute appendicitis, were included in the study. Patients with an appendicular mass, peritonitis due to perforation, abscess, previous abdominal surgery and large ventral hernia were excluded. A detailed history of the patients was taken, and physical examination, a complete blood analysis, urine examination and ultrasound of the abdomen were routinely performed in all the cases. The patients were explained about the risks and the benefits of the two procedures and their informed consent was obtained. All the patients were randomly divided into group A [LA] and group B [OA]. Six patients of group A were selected for laparotomy and appendectomy, but because of technical problems, adhesions and missing of the appendix, they were excluded from the study. The patients were operated by two consultant surgeons who had sufficient capability of performing the two procedures, under spinal anaesthesia. General anaesthesia was reserved for the uncooperative patients. LA was performed through a three port technique and carbon dioxide was used to create the pneumoperitoneum. The Open Hassan technique or the Verres needle were used for creating the pneumoperitoneum, followed by a 10mm trocar insertion at the sub umbilical and the other two 5mm ports were placed in both sides of the lower abdomen, preferabably below the bikini line. The dissection and mobilization of the appendix were performed by using bipolar coagulation. The appendix was divided at the base between the two endoloops. The retrieval of the resected appendix was performed through the umbilical port and the appendix was sent for histopathogical examination. OA was performed through a McBurney or Lanz incision. The peritoneum was accessed by muscle splitting and the appendix was delivered into the wound, which was removed in the usual manner. All the operative details were recorded. The operative time for both the procedures was noted, right from making the skin incision till the last stitch was applied. The patients were kept nil by mout till the return of the bowel sounds. A soft diet, followed by regular diet, was introduced when the patients tolerated the liquid diet and had passed flatus. The pain was measured qualitatively by using a visual analog scale. The length of the hospital stay was determined as the number of nights which were spent in the hospital. The patients were discharged after they resumed a regular diet, were afebrile and had good pain relief. The post operative complications were noted in a profroma during the hospital stay and till one month [follow up visit on the 8th day]. ‘Wound infection’ was defined as redness or purulent or seropurulent discharge from the incision site, which was observed within 30 days postoperatively. ‘Seroma’ was defined as a localized collection without redness. ‘Paralytic ileus’ was defined as the failure of bowel sounds to return within 12 hours post operatively.
STATISTICAL ANALYSIS
The data were analyzed by using the Statistical Package for Social Sciences. Continuous variables such as age, hospital stay, and operative time were presented as mean +/- SD, while the categorical variables such as gender and post-operative complication were expressed as frequency and percentages by using a 90% confidence interval. The Student’s t-test was used to compare the means of the continuous variables, while the categorical variables were compared by using the Chi-square or the Fisher’s exact test as appropriate. A probability which was equal to or less than 0.05 [P< 0.05] was considered as significant.

Results

The comparisons of the patient’s demographics and clinical features are summarized in (Table/Fig 1). No significant statistical differences were noted in both the groups with respect to age, sex and pain duration. The operative details and the postoperative characteristics are noted in (Table/Fig 2). Out of 114 patients in the LA group, 28 patients had complicated appendicitis, while 32 patients in the OA group had complicated appendicitis such as perforation and gangrenous changes. The median operative time in the OA [49.2 min] group was significantly shorter [p< 0.0139] than that in the LA [72.5 min] group, as shown in (Table/Fig 3). The post-operative pain was qualitatively stratified into mild, moderate and severe, according to the visual analog scale (VAS). Even though the relatively early pain was more or less equal in the LA group than in the OA group, later, it was significantly less [p< 0.0123] as compared to that in the OA group. The post operative hospital stay was 2.5+_ 0.54 days in the LA group as compared to 4.25+- 0.67 days in the OA group, which was not statistically significant [p< 0.2510]. There were no statistically significant differences in the wound infection rates in both the groups [LA-9 (7.89%) as compared to OA-14(11.6%)], but one patient in the LA group had stump appendicitis. The patient was readmitted and underwent laparotomy with appendectomy for diverticulitis. The entire specimen was sent for histopathological confirmation. Totally, three patients had negative appendicitis, of which two patients of the LA group suffered from torsion of the ovary and one patient in the OA group had Meckel’s diverticulum.

Discussion

In the last two decades, LA has gained a lot of popularity around the world. Laparoscopy is the most preferred surgical procedure for gastro oesophageal reflux disease and gall bladder disease. Similarly, the same procedure is widely applied for appendectomy. In spite of a lot of case series and a large number of randomized clinical trials over more than two decades, the benefits of LA over AP are still controversial (5),(6),(7). The results of our trial clearly demonstrated the superiority of laparoscopic appendectomy over open appendectomy regarding the postoperative pain, hospital stay, the functional status and the complication rates. An early diagnosis with prompt surgery is the preferred treatment option for preventing complications such as perforation, that can lead to an increase in the morbidity. The laparoscopic skills of experienced laparoscopic surgeons can be transferred to different operations without increasing the morbidity. Minimal invasive surgery requires different skills and technical knowledge. So, the results of many studies were influenced by the experience and technique of the surgeons. In our study, LA could be safely performed in 95% cases, despite the fact that 23.34% of the patients had complicated appendicitis. The rate of the conversion was 5% (Table/Fig 4) and out of it, three cases had an appendicular mass, the appendix could not be identified in one case, there was technical difficulty in two cases and the results were comparable to and were less than other series (2),(8), (9),(10),(11). In one case of OA, a Meckel’s diverticulum was found and it was removed. In this aspect, definitely LA is superior to OA because the peritoneal cavity can be completely visualized. In two cases which were selected for LA, the torsion of an ovarian cyst was found and hence, appendectomy was avoided. The high rate of misdiagnosis in females may be due to gynaecological problems and the female functional abnormalities. So, in a patient with suspected appendicitis, LA improves the diagnostic accuracy and also avoids unnecessary appendectomy (12). The operative duration was 23 minutes longer in the LA group as compared to that in the OA group. In most of the literature, the operating time in laparoscopic appendectomy was found to be more than that in open appendectomy. The difference of the mean time ultimately depends upon the experience of the surgeon and the competence of the team. The reasons for the prolongation include the extra steps for the setup, insufflations, trocar insertion and diagnostic laparoscopy. Our study was comparable with the following series of articles with respect to the operative duration (7), (11), (13), (14) (Table/Fig 3). The hospital stay in our study was significantly less in LA than in OA [>24hours] and this was similar to the findings of other reported series (15), (16). Li et al’s (17) meta analyses (2010) showed a lot of controversies in the hospital stay before the year 2000, but after that, it became more significant. This discrepancy may be due to the social standards, the insurance system and the health care policies. Some authors (18) argue that the appendiceal pathology was a major determinant of the length of the hospital stay. Patients with complicated appendicitis were most likely to require an extended hospital stay. An early return to full activity one week before in the LA group was observed in the study and it was comparable with the findings of other reported series (12), (19). This was supported by the Cochrane Colorectal Cancer Group (15). Minimal trauma and less pain following LA allowed an early recovery. Fast resumption of a normal diet in LA was another added advantage due to the minimal handling of the bowel. We qualitatively assessed the post-operative pain by means of a VAS on the first three consecutive days and this was quantitatively assessed by the daily requirement of analgesics. The pain was significantly less in the LA group (Table/Fig 2) in our study. Meta analyses by Li et al (17) in 2010 also supported this study, mainly due to the less invasive nature of the procedure. This study was not blinded and so the assessment of the pain may not be so accurate. Many literature searches and meta analyses showed that there was a risk of intra-abdominal abscess (17), (20), (21), (22), but we did not have any intra abdominal abscesses in our study. Kathouda et al (7), believed that mastery of the learning curve and the use of standard guide lines definitely reduced the incidence of the intra abdominal abscesses. The reduced wound infection and the post-operative paralytic ileus can be beneficial in so many ways: less pain, an early oral intake and early mobilization, all resulting ultimately in a reduced hospital stay. In our study, the post operative complications were 7.89% (9) in the LA group as compared to11.6% (14) in the OA group. This study was comparable to other reported series (23), (24). Our study concluded that the change in surgical approach in managing suspected appendicitis is safe and effective. Despite a prolonged operative time, LA was found to be superior to OA with respect to the postoperative pain, hospital stay, early recovery, wound infection and cosmesis. The added advantage of laparoscopic appendectomy is its improved diagnostic ability.

References

1.
Addis DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990; 132:910-25.
2.
Kumar B, Samad A, Khanzad TA, Laghari MH, Sheikh AR. Superiority of laparoscopic appendectomy over open appendectomy: the Hyderabad experience. Rawal Med J 2008; 165-68.
3.
Mc Burney C. An incision is made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg 1894;20:38-43.
4.
Semm K . Endoscopic appendectomy. Endoscopy 1983;59-64.
5.
Apelgren K, Molnar R, Kiasia J. Laparoscopy is not better than open appendectomy. Am Surg 1995;61:240-43.
6.
Reiertsen O, Larsen S, Trondsen E, Edwin B, Faerden A. A randomized, controlled trial with a sequential design of laparoscopic versus conventional appendectomy. Br J Surg 1997;84:842-47.
7.
Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R. Laparoscopic versus open appendectomy: a prospective randomized double blind study. Ann Surg 2005;242:439-48.
8.
Swank HA, Eshuis EJ, Van Berge Henegouwen MI, Bemelman WA. Short and long term results of open versus laparoscopic appendectomy. World J Surg 2011;35:1221-26.
9.
Lujan-Mompean JA, Compos R R, Paricio P P, Aledo S V, Ayllon G J. Laparoscopic versus open appendectomy : a prospective assessment. Br J Surg 1994;81:133-35
10.
Minne L, Narner D, Burnell A , Ratzer E, Clark J, Hatin W. Laparoscopic versus open appendectomy : a prospective, randomized study of the outcomes. Arch Surg 1997;132:708-11.
11.
Ortega A, Hunter J, Peter J, Swanstrom L, Schrimer B. A prospective, randomized comparison of LA versus OA . Am J Surg 1995;169: 208-13.
12.
Jamy LY, Lo C Y, Lam CM. A comparative study of routine laparoscopic versus open appendectomy. JSLS 2006;10:188-92.
13.
Reierston O, Larsen S , et al. A randomized controlled trial with a sequential design of laparoscopic versus conventional appendectomy. Br J Surg 1997; 84: 842-47.
14.
Khalil J, Muqim M, Rafique M, Khan M. Laparoscopic versus open appendectomy : a comparison of the primary outcome measures. Saudi J Gastroenterol 2011;17:236-40.
15.
Hansen JB, Smitherd BM, Schache D, Wall DR, Miller BJ, Menzier BL. Laparoscopic versus open appendectomy. Wourld J Surg 1996;20: 17-20.
16.
Sauerland S, Jaschinski T, Neugebaner EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2010;10: CD001546.Review.
17.
Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: a meta analysis. J Am Coll Surg 1998;186:545-53.
18.
Li et al. Laparoscopic versus conventional appendectomy : a metaanalysis of randomized controlled trials. BMC Gastrol 2010;10:129
19.
Kurtz R, Heimann T. Comparison between the open and laparoscopic treatment of acute appendicitis. Am J Surg 2001;182:211-14.
20.
Pederson AG, Peterson OB, Wara P, Ronning H, Qvist N, Laurberg S. A randomized clinical trial of laparoscopic versus open appendectomy. Br J Surg 2001;88:200-05.
21.
Gupta R, Sample C, Bamehriz F, Birch DW. Infectious complications following laparoscopic appendectomy. Can J Surg 2006;49:397-00.
22.
Memon MA. Laparoscopic appendectomy : current status. Ann R Coll Surg Eng 1997;79:393-402.
23.
Brummer S, Sohr D, Gastmeier P. Intra abdominal abscess and LA versus OA . Infect Control Hosp Epidemiol 2009;30:713-15.
24.
Yau KK, Siu WT, Tanq CN, Yanq GP, Li MK. Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 2007;205:60-65.
25.
Aziz O, Athansiou T, Tekkis PP, Purkayastha S, Haddow J, Malinovski V et al. Laparoscopic versus open appendectomy in children : a metaanalysis. Ann Surg 2006;243:17-27.

DOI and Others

JCDR/2011/1772

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com