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Oct19
Efficacy of surgical techniques and factors affecting residual stone rate in the treatment of kidney stones
Original Research
Efficacy of surgical techniques and factors affecting residual stone rate in
the treatment of kidney stones
Dr. Anil Haripriya


1Associate professor, Department of General Surgery CIMS, Bilaspur (C.G.), India;
2Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur (M.P.), India
ABSTRACT:
Background: The present study was conducted to assess efficacy of surgical techniques and factors affecting residual stone
rate in the treatment of kidney stones. Materials & Methods: 102 patients of kidney stones of both genders were divided
into 3 groups. Group I patients underwent open stone surgery, group II patients underwent percutaneous nephrolithotomy
(PNL) and group III underwent retrograde intrarenal surgery (RIRS). Surgical techniques complications were evaluated.
Results: In group I mean stone burden was 3.2 cm2

, in group II was 2.5 cm2

and in group III was 1.9 cm2
. The mean
operative time in group I was 84.2 minutes, in group II was 118.4 minutes and in group III was 78.6 minutes. There were 9
cases in group I, 7 in group II and group III was 5 cases. There were 7 cases of fever in group I, 4 in group II and 2 in group
III, infection 2 in group I and 3 in group III, urine leakage 5 in group III and persistent pain 6 in group I and 1 in group II.
The difference was significant (P< 0.05). Conclusion: PNL and RIRS have been seen as safe and effective methods as
compared to open method in case of kidney stones.
Key words: Percutaneous nephrolithotomy, Retrograde intrarenal surgery, Kidney stone.
Received: 13 September, 2020 Accepted: 18 November, 2020
Correspondence: Dr. Arvind Baghel, Associate Professor, Department of General Surgery, NSCB Medical College,
Jabalpur (M.P.), India
This article may be cited as: Haripriya A, Baghel A. Efficacy of surgical techniques and factors affecting residual stone
rate in the treatment of kidney stones. J Adv Med Dent Scie Res 2020;8(12):55-58.
INTRODUCTION
Urinary system stone disease is one of most
frequently encountered diseases in the urology
practice. The stones are frequently observed in the
renal localization, and most of them require
intervention.1 Kidney stone disease, also known as
urolithiasis or renal calculi contributes to one of the
most common health problems in the daily lives of
men and women. It occurs when a solid piece of
material (stone) forms in the urinary tract.2
Approximately 12% of men and 6% of women in the
USA and 10 to 15% of people in Europe and North
America are affected by it. Calcium oxalate (CaOx) is
found to one component of the most common kidney
stones. It has been proposed that the most likely stone
formation mechanism for people with idiopathic
CaOx stones is caused by CaOx overgrowth in renal
papillary Randall’s plaque.
3
Preventive measures such
as dietary therapy and therapeutic treatments such as
drugs and surgical techniques have been verified to be

effective in the treatment of renal calculi. Dietary
modification is a safe and economical preventive
measure for dietary therapy, and in some cases, drugs
are important to reduce the risk of stone formation.
Unfortunately, since the 1980s, there have been no
new drugs developed for the prevention of renal
calculi after the introduction of potassium citrate.4
Some of these methods include percutaneous
nephrolithotomy (PCNL), extracorporeal shockwave
lithotripsy (SWL), retrograde intrarenal surgery
(RIRS), etc. Extracorporeal shock wave lithotripsy
(ESWL) into clinical practice after 1980s, a new era
had begun in the treatment of urinary system stone
disease. In recent years, percutaneous
nephrolithotomy (PNL) has taken increasingly greater
part in the treatment of stone disease with success
rates nearing to 80 percent.5 The present study was
conducted to assess efficacy of surgical techniques
and factors affecting residual stone rate in the
treatment of kidney stones.
Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies NLM ID: 101716117
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 85.10

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Haripriya A et al. Treatment of kidney stones.

56

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
MATERIALS & METHODS
The present study was conducted among 102 patients
who underwent surgical treatment of kidney stones of
both genders in the department of general surgery in a
medical college hospital. All were informed regarding
about the study and their consent was obtained.
Data such as name, age, gender etc. was recorded.
Patients were divided into 3 groups. Group I patients
underwent open stone surgery, group II patients
underwent percutaneous nephrolithotomy (PNL) and

group III underwent retrograde intrarenal surgery
(RIRS).
Endoscopic stone surgery was performed for stone
fragmentation in all patients using pneumatic
lithotriptor or Holmium: YAG laser. Surgical
techniques complications were evaluated. Stones
equal or larger than 4 mm were considered as residual
stones. The dimensions of the stones were calculated
and measured in cm2

. Results thus obtained were
subjected to statistical analysis. P value less than 0.05
was considered significant.

RESULTS
Table I Distribution of patients

Groups Group I Group II Group III
Methods Open stone surgery PNL RIRS
M:F 34 34 34

Table I shows that group I patients underwent open stone surgery, group II patients underwent PNL, and group
III underwent RIRS. Each group had 34 patients.
Table II Assessment of parameters

Parameters Group I Group II Group III P value
Stone burden (cm2

) 3.2 2.5 1.9 0.01
Operative time (mins) 84.2 118.4 78.6 0.001
Length of hospital stay 3.2 3.0 1.4 0.05
Cases with residual stone 9 7 5 0.02
Table II shows that in group I mean stone burden was 3.2 cm2

, in group II was 2.5 cm2

and in group III was 1.9

cm2
. The mean operative timein group I was 84.2 minutes, in group II was 118.4 minutes and in group III was
78.6 minutes. There were 9 cases in group I, 7 in group II and group III was 5 cases. The difference was
significant (P< 0.05).
Table III Assessment of complications in groups

Complications Group I Group II Group III P value
Fever 7 4 2 0.02
Infection 2 0 3 0.05
Urine leakage 0 0 5 0.05
Persistent pain 6 1 0 0.001

Table III, graph I shows that there were 7 cases of fever in group I, 4 in group II and 2 in group III, infection 2
in group I and 3 in group III, urine leakage 5 in group III and persistent pain 6 in group I and 1 in group II. The
difference was significant (P< 0.05).
Graph I: Assessment of complications in groups

0
1
2
3
4
5
6
7

Fever Infection Urine leakage Persistent pain
7

2

0

6

4

0 0

1

2

3

5

0

Group I
Group II
Group III

Haripriya A et al. Treatment of kidney stones.

57

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
DISCUSSION
Currently, a diverse range of non-invasive, minimally
invasive and invasive methods have been reported as
treatment approaches for renal calculi. Recent studies
have reported that flexible ureterorenoscopy
(URS)/holmium laser lithotripsy can be an alternative

treatment for patients with renal calculi. The micro-
percutaneous nephrolithotomy (microperc) is a

recently described technique in which percutaneous
renal access and lithotripsy are performed in a single
step. Microperc has been found to be safe and
effective in removing small renal calculi in the adult
and pediatric populations with a high stone-free rate
and lower complication rate.6 Despite all the new
approaches, shock wave lithotripsy (SWL) remains
the first line treatment modality that is widely used for
renal, ureteral and intermediate-size renal calculi. Its
success rates from contemporary series vary from 60
to 90%. However, during an SWL procedure,
physicians should consider the association between
SWL-related pain and patients’ positioning, which
may negatively affect the SWL success rate as well as
its potential complications. PCNL can be divided into
two types: minimally invasive percutaneous
nephrolithotomy (mini-PCNL) and standard
percutaneous nephrolithotomy (standard PCNL).7
Mini-PCNL has a higher efficacy and better safety in
the management of small renal calculi, while standard
PCNL is still regarded as the conventional technique
for the treatment of large renal stones in the upper
urinary tract. However, in the recent years, there has
been a shift in trend to favor a mini-PCNL approach
in order to reduce the morbidities.8The present study
was conducted to assess efficacy of surgical
techniques and factors affecting residual stone rate in
the treatment of kidney stones.
In present study, group I patients underwent open
stone surgery, group II patients underwent PNL, and
group III underwent RIRS. Each group had 34
patients. Ayedemir et al9

included records of 109
cases of kidney stones. Patients were divided into
three groups in terms of surgical treatment; open stone
surgery, percutaneous nephrolithotomy (PNL) and
retrograde intrarenal surgery (RIRS). Patients’ history,
physical examination, biochemical and radiological
images and operative and postoperative data were
recorded.The patients had undergone PNL (n=74;
67.9%), RIRS (n=22;20.2%), and open renal surgery
(n=13; 11.9%). The mean and median ages of the
patients were 46±9, 41 (21–75) and, 42 (23–67) years,
respectively. The mean stone burden was 2.6±0.7 cm2
in the PNL, 1.4±0.1 cm2 in the RIRS, and 3.1±0.9
cm2 in the open surgery groups. The mean operative
times were 126±24 min in the PNL group, 72±12 min
in the RIRS group and 82±22 min in the open surgery
group. The duration of hospitalisation was 3.1±0.2
days, 1.2±0.3 days and 3.4±1.1 days respectively.
While the RIRS group did not need blood transfusion,
in the PNL group blood transfusions were given in the
PNL (n=18), and open surgery (n=2) groups. Residual

stones were detected in the PNL (n=22), open surgery
(n=2), and RIRS (n=5) groups.
We found that in group I mean stone burden was 3.2
cm2
, in group II was 2.5 cm2

and in group III was 1.9

cm2
. The mean operative time in group I was 84.2
minutes, in group II was 118.4 minutes and in group
III was 78.6 minutes. There were 9 cases in group I, 7
in group II and group III was 5 cases. Stone-free rate
in percutaneous nephrolithotomy can vary dependent
on the stone location, and size, as reported in the
literature, it increases up to 90 percent. In the AUA
guideline, this rate has been given as 78 percent. In
our study, in 74 patients, a 70.3% stone-free rate has
been detected. Size, location, composition of the
stone, anatomy of the affected kidney, and experience
of the surgeon are effective on success, and
complications of PNL.10
We found that there were 7 cases of fever in group I, 4
in group II and 2 in group III, infection 2 in group I
and 3 in group III, urine leakage 5 in group III and
persistent pain 6 in group I and 1 in group II.
Lingeman et al11reported 88–91% success rates for
stones with a diameter of 1–3 cm, mean success rate
decreased to 75% in stones larger than 3 cm in
diameter. Still Clayman et al12reported success rates
as 89.2, and 97–100% for stone with a stone burden of
>2, and <2 cm2

, respectively.
CONCLUSION
Authors found that PNL and RIRS have been seen as
safe and effective methods as compared to open
method in case of kidney stones.
REFERENCES
1. Karatag T, Buldu I, Inan R, Istanbulluoglu MO: Is
MicropercutaneousNephrolithotomy Technique Really
Efficacicous for the Treatment of Moderate Size Renal
Calculi? Yes. UrolInt 2015;95:9-14.
2. Kim BS: Recent advancement or less invasive treatment
of percutaneous nephrolithotomy. Korean J Urol
2015;56:614-623.
3. Hyams ES, Munver R, Bird VG, Uberoi J, Shah O:
Flexible ureterorenoscopy and holmium laser lithotripsy
for the management of renal stone burdens that measure
2 to 3 cm: a multi-institutional experience. J Endourol
2010;24:1583-1588.
4. Sabnis RB, Ganesamoni R, Ganpule AP, Mishra S,
Vyas J, Jagtap J, Desai M: Current role of microperc in
the management of small renal calculi. Indian J Urol
2013;29:214-218.
5. Knoll T, Buchholz N, Wendt-Nordahl G: Extracorporeal
shockwave lithotripsy vs. percutaneous nephrolithotomy
vs. flexible ureterorenoscopy for lower-pole stones.
Arab J Urol 2012;10:336-341.
6. Capitanini A, Rosso L, Giannecchini L, Meniconi O,
Cupisti A: Sepsis complicated by brain abscess
following ESWL of a caliceal kidney stone: a case
report. IntBraz J Urol 2016;42:1033-1036.
7. Kim JK, Ha SB, Jeon CH, Oh JJ, Cho SY, Oh SJ, Kim

HH, Jeong CW: Clinical Nomograms to Predict Stone-
Free Rates after Shock-Wave Lithotripsy: Development

and Internal-Validation. PLoS One 2016;11:e0149333.

Haripriya A et al. Treatment of kidney stones.

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Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
8. Kang JH, Lee SW, Moon SH, Sung HH, Choo SH, Han
DH: Relationship Between Patient Position and Pain
Severity During Shock Wave Lithotripsy for Renal
Stones With the MODULITH SLX-F2 Lithotripter: A
Matched Case-Control Study. Korean J Urol
2013;54:531-535.
9. Aydemir H, Budak S, Kumsar Ş, Köse O, Sağlam HS,
Adsan Ö. Efficacy of surgical techniques and factors
affecting residual stone rate in the treatment of kidney
stones. Turkish journal of urology. 2014 Sep;40(3):144.
10. Wong C, Leveillee RJ. Single upper-pole percutaneous
access for treatment of > or = 5-cm complex branched

staghorn calculi: is shockwave lithotripsy necessary? J
Endourol. 2002;16:477–81.
11. Lingeman JE, Coury TA, Newman DM, Kahnoski RJ,
Mertz JH, Mosbaugh PG, et al. Comparison of results
and morbidity of percutaneous nephrostolithotomy and
extracorporeal shock wave lithotripsy. J Urol.
1987;138:485–90.
12. Clayman RV, Mcdougall EM, Nakada SY. Endourology
of the upper urinary tract: percutaneous renal and
ureteral procedures. In: Wals PC, Retik AB, Vaughan
EJ, Wein AJ, editors. Campbell’s urology. Philadelphia:
WB Saunders; 1998; 2789–874.


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Oct19
A comparative study of laparoscopic appendectomy versus open appendectomy for the treatment of acute appendicitis
Original Research
A comparative study of laparoscopic appendectomy versus open
appendectomy for the treatment of acute appendicitis
Dr. Anil Haripriya



1Associate professor, Department of General Surgery CIMS, Bilaspur (C.G.), India;
2Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur (M.P.), India
ABSTRACT:
Background: The present study was conducted to compare open versus laparoscopic appendectomy in acute appendicitis.
Materials & Methods: 68 cases of acute appendicitis were divided into 2 groups. Group I patients were subjected to laparoscopy
appendectomy and Group II patients subjected to open appendectomy. Results: Symptoms were nausea/vomiting seen 28 in
group I and 26 in group II, abdominal pain 32 in group I and 33 in group II and fever in 25 in group I and 21 in group II. The
difference was non- significant (P> 0.05). Oral feed started postoperatively at mean of 5.9 days in group I and 2.6 days in group
II, average hospital stay was 5.6 days in group I and 4.2 days in group II. Wound abscess was seen in 3 days in group I and 4
days in group II and wound infection 2 days in group I and 8 days in group II. The difference was significant (P< 0.05).
Conclusion: Laparoscopic appendectomy is effective method of acute appendicitis as compared to open appendectomy.
Key words: Acute appendicitis, Laparoscopic appendectomy, Oral feed
Received: 11 September, 2020 Accepted: 16 November, 2020
Correspondence: Dr. Arvind Baghel, Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur
(M.P.), India
This article may be cited as: Haripriya A, Baghel A. A comparative study of laparoscopic appendectomy versus open
appendectomy for the treatment of acute appendicitis. J Adv Med Dent Scie Res 2020;8(12):42-45.
INTRODUCTION
Acute appendicitis is the most common emergent
abdominal condition requiring surgical intervention.
Appendicitis is inflammation of the appendix.
1
Symptoms commonly include right lower abdominal
pain, nausea, vomiting, and decreased appetite.
However, approximately 40% of people do not have
these typical symptoms. Severe complications of a
ruptured appendix include widespread, painful
inflammation of the inner lining of the abdominal wall
and sepsis.
2
Appendicitis is the most common cause of the acute
abdomen in the United States, with an estimated
lifetime risk between 5 and 20%. In fact, appendectomy
is the most common non-elective operation performed
by general surgeons. Although it has been over 115
years since Reginald Heber Fitz first demonstrated the

natural history and pathophysiology of appendicitis and
advocated early appendectomy in his landmark article,
appendicitis continues to present challenges for the
surgeon today.3
Appendectomy is the most commonly performed
operation in the world, 6% of all the surgical procedures
and is done as emergency procedure wherever possible,
the only exception is formation of appendicular mass or
abscess. In these cases, interval appendectomy is
performed as elective procedure.4
Laparoscopic appendectomy gives a better evaluation of
the peritoneal cavity than that obtained by open
approach and also facilitates other differential
diagnosis. Advantages of laparoscopic approach include
less operative time, less postoperative pain, reduced
analgesia, less surgery associated complications, shorter
hospital stay, faster recovery, reduced wound infection

Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies NLM ID: 101716117
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 85.10

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Haripriya A et al. Laparoscopic appendectomy versus open appendectomy.

43

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
and minimal scarring.5 The present study was
conducted to compare open versus laparoscopic
appendectomy in acute appendicitis.
MATERIALS & METHODS
The present study was conducted in the department of
general surgery in a medical college hospital. It
comprised of 68 cases of acute appendicitis. Patients
were informed regarding the study and written consent
was taken.

Patient information such as name, age, gender etc. was
recorded. Patients were diagnosed on the basis of
physical examination, laboratory tests and ultrasound
examination (USG). Patients were divided into 2
groups. Group I patients were subjected to laparoscopy
appendectomy and Group II patients subjected to open
appendectomy. Patients were monitored for pulse rate,
blood pressure, temperature, respiratory rate, bowel
sounds and urinary output. Patients were put on follow
up at 1 week, 2 weeks and 4 weeks after surgery. P
value less than 0.05 was considered significant.

RESULTS
Table I Distribution of patients

Groups Group I Group II
Number Laparoscopy appendectomy Open appendectomy
Number 34 34

Table I shows that group I patients were subjected to laparoscopy appendectomy and group II patients subjected to
open appendectomy.
Table II Assessment of symptoms

Symptoms Group I Group II P value
Nausea/vomiting 28 26 0.97
Abdominal pain 32 33 0.94
Fever 25 21 0.91

Table II shows that symptoms were nausea/vomiting seen 28 in group I and 26 in group II, abdominal pain 32 in
group I and 33 in group II and fever in 25 in group I and 21 in group II. The difference was non- significant (P>
0.05).
Table III Assessment of parameters

Parameters Group I Group II P value
Oral feed started postoperatively 5.9 2.6 0.01
Average hospital stay 5.6 4.2 0.05
Wound abscess 3 4 0.05
Wound infection 2 8 0.01

Table III, graph I shows that oral feed started postoperatively at mean of 5.9 days in group I and 2.6 days in group II,
average hospital stay was 5.6 days in group I and 4.2 days in group II. Wound abscess was seen in 3 days in group I
and 4 days in group II and wound infection 2 days in group I and 8 days in group II. The difference was significant
(P< 0.05).
Graph I Assessment of parameters

0
1
2
3
4
5
6
7
8

Oral feed started
postoperatively

Average hospital
stay

Wound abscess Wound infection

5.9 5.6

3

2

2.6

4.2 4

8

Group I
Group II

Haripriya A et al. Laparoscopic appendectomy versus open appendectomy.

44

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
DISCUSSION
The diagnosis of acute appendicitis is often difficult,
and challenging. The most common cause of surgical
abdomen is appendicitis affecting all the age groups.6
The maximum incidence is documented to be about 7-
10 % of the general population in the second and third
decades of life.7 Appendectomy is the operation which
is most commonly performed by the general surgeons.
The Laparoscopic appendectomy was first performed
by Semm K, German Gynaecologist.8

It has gained
acceptance with the technological advances of the past
two to three decades as a diagnostic and treatment
method for acute appendicitis. From that time, this
procedure has been used widely. In spite of its wide
acceptance, there remains a continuing debate in the
literature related to the most appropriate way of
removing the inflamed appendix.9 The present study
was conducted to compare open versus laparoscopic
appendectomy in acute appendicitis.
In present study, group I patients were subjected to
laparoscopy appendectomy and group II patients
subjected to open appendectomy. Burra et al10 in their
study a total 140 patients admitted with clinical
diagnosis of acute or recurrent appendicitis. They were
divided into two groups: open appendectomy (OA)
group with 70 patients in each) and laparoscopic
appendectomy (LA) group (70 patients in each). OA
was performed through standard Mc Burney incision. A
standard 3-port technique was used in this study for the
laparoscopic procedure. It is found that laparoscopic
appendectomy is as safe and effective as the open
procedure. The pain score was reduced in laparoscopic
which is 3.4±1.8 and in open 4.2±1.4. This difference
was found to be statistically significant at p value of
0.05. The duration of analgesics was also reduced in
laparoscopic with mean value of 4.81±3.6 and
10.32±4.2 and this difference was found to be
statistically significant at p value of 0.05.
We found that symptoms were nausea/vomiting seen 28
in group I and 26 in group II, abdominal pain 32 in
group I and 33 in group II and fever in 25 in group I and
21 in group II. Gupta et al11 compared and evaluated the
open and laparoscopic method of appendectomy in
acute appendicitis. The subjects undergoing
appendectomy were evaluated for age, sex, episode
number, duration of pain before presentation in
hospital, operative time, conversion rate, wound
infection, post-operative intra-abdominal abscess
formation, and stay in hospital. It was found that
average operative time in open surgery was 67.5
minutes and 104 minutes in laparoscopic surgery, with
a conversion to open in about 20% of the cases. Oral
feeding in the open group was around the 5th day while
it was around 2nd day in the laparoscopic group.
Average hospital stay was also low in the laparoscopic
group, being only around 5 days in laparoscopic group

and around 8 days in the open group. Overall
complications were also low in the laparoscopic surgery
group.
We observed that oral feed started postoperatively at
mean of 5.9 days in group I and 2.6 days in group II,
average hospital stay was 5.6 days in group I and 4.2
days in group II. Wound abscess was seen in 3 days in
group I and 4 days in group II and wound infection 2
days in group I and 8 days in group II.
Another study by Garg CP12 which studied a total of
110 patients, 61 of whom underwent open
appendectomy and the rest 49 underwent laparoscopic
appendectomy. Operative time was noted to be higher
in laparoscopic surgery, also it was noted that
laparoscopic surgery was associated with less analgesic
use, shorter hospital stay.
The shortcoming of the study is small sample size.
CONCLUSION
Authors found that laparoscopic appendectomy is safer
and effective method for patients of acute appendicitis
as compared to open appendectomy.
REFERENCES
1. Chiarugi M, Buccianti P, Celona G, Decanini L,
Martino MC, Goletti O et al. Laparoscopic compared
with open appendectomy for acute appendicitis: A
prospective study. Eur J Surg 1996; 162(2): 385–390.
2. Garbutt JM, Soper NJ, Shannon W, Botero A,
Littenberg B. Meta-analysis of randomized controlled
trials comparing laparoscopic and open appendectomy.
Surg Laparosc Endosc. 1999; 9(4):17-26.
3. Akshatha Manjunath, Aparajita Mookherjee.
Laparoscopic versus open appendectomy: An analysis
of the surgical outcomes and cost efficiency in a tertiary
care medical college hospital. International Journal of
Contemporary Medical Research 2016; 3(6):1696-
1700.
4. Di Saverio S. Emergency laparoscopy: a new emerging
discipline for treating abdominal emergencies
attempting to minimize costs and invasiveness and
maximize outcomes and patients’ comfort. J Trauma
Acute Care Surg. 2014; 77(1):338–50.
5. Hansen JB, Smithers MB, Schache D, Wall DR, Miller
BJ, Menzies BL. Laparoscopic versus open
appendectomy: prospective randomized trial. World J
Surg 1996; 20(5): 17–21.
6. Klingler A, Henle KP, Beller S, Rechner J, Zerz A,
Wetscher GJ. Laparoscopic appendectomy does not
change the incidence of postoperative infectious
complications. Am J Surg 175(3): 232–35.
7. Kurtz RJ, Heimann TM. Comparison of open and
laparoscopic treatment of acute appendicitis. Am J Surg.
2001; 182(6):211–4.
8. Chung RS, Rowland DY, Li P, Diaz J. A metaanalysis
of randomized controlled trials of laparoscopic versus
conventional appendectomy. Am J Surg. 1999;
177(1):250–6.

Haripriya A et al. Laparoscopic appendectomy versus open appendectomy.

45

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
9. Hellberg A, Rudberg C, Kullmann E, et al. Prospective
randomized multicentre study of laparoscopic versus
open appendectomy. Br J Surg. 1999; 86(4):48–53.
10. Burra Viswa Chaitanya, Rama Chandra Mohan
Mallapragada. Comparative evaluation of laparoscopic
with open appendectomy among patients of
appendectomy - A prospective study. International
Journal of Contemporary Medicine Surgery and
Radiology. 2019;4(3):C18-C22.
11. Gupta A, Singh AP. Comparative Evaluation of Open
and Laproscopic Method of Appendectomy in Acute
Appendicitis. Journal: Academia Journal of Surgery.
2020(1):8-11.
12. Garg CP, Vaidya BB, Chengalath MM. Efficacy of
laparoscopyin complicated appendicitis. Int J Surg.


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