| Background:An appendectomy is the surgical removal of the appendix, a tube about six inches long or less, that branch off the large intestine. There are two methods to perform this procedure either open-method or laparoscopic. After the introduction of minimum invasive surgery such as Laparoscopic surgery the incidences of complications have had a decreasing number throughout the years. Laparoscopic appendectomy is not yet unanimously considered the "gold standard" in the treatment of acute appendicitis because of its higher operative time, intra-abdominal abscess risk, and costs compared to open appendectomy. The other method being Open method. The surgeon locates the appendix and removes it through the incision. As with any surgical procedure, complications may occur. The main purpose of this paper is to qualitatively review recently conducted randomized control trials of Laparoscopic surgery and open surgery for Appendectomy in a complicated setting. This thesis will also mention in detail how the both procedures are conducted their advantages and disadvantages and complication to give the reader a comprehensive knowledge of both procedures. According to numerous researches, articles and journals published, both surgeries are one of the most common procedures performed with multiple advantages and is highly recommended with positive outcomes, both of them still carry a inherent risk of complications, disadvantages and a less satisfactory cosmetic outcome.Objective:This main objective of this thesis is to systematically review two recently conducted randomized control trials in an empirical qualitative method and come to concise conclusion.Method:A search was conducted on multiple online available databases from the year start from 2014 till 2016, and two RCT's were selected using terms related to open versus laparoscopic appendectomy and complicated appendicitis, the databases being Pubmed, Cochrane and Embase. The RCT's available free of cost and for public viewing wTere selected after the inclusion and exclusion criteria. The two RCTs were reviewed and scored with JADAD scoring system, data abstraction was performed and the two trials were narrowed to a summarized version. PRISMA chart were made to show the process of searching the RC's and as well as summarizing both the researches. No software was used and review was conducted using pen and paper. It should also be noted one trials is no longer available for free, the Thomson trial paper is available on ‘research gate' as free but the Taguchi trial is no longer available and has to be purchased, during the time of this research both were available. Meta-analysis was not conducted and this systematic review is presented in a narrative form. There are numerous other researches conducted in the same manner otherwise known as either just systematic review or empirical research analyzed qualitatively.RESULT:Out of numerous researches and published articles it was narrowed to down only 2 trials conducted on 2014 and on 2015, as this thesis only deals with recent randomized control trials in a complicated scenario and as mentioned in Thompson's 2014 trial, it was the first ever RCT conducted for LA versus OA in complicated appendicitis.This reviews focus was in respect to operating time, conversion rate, post-op hospital stay, complications, morbidity and return to normal activity. This review also in a qualitative fashion systematically analyzed both the trials.CONCLUSION:After careful analysis of the data extracted through recursive abstraction and grading both the trials through JADAD, it was clearly evident to say that Laparoscopic surgery for complicated appendicitis is safe and feasible but no distinguishing characteristic was found which would put Laparoscopic over open procedure. |
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