Acute Appendicitis, Appendicitis (Diagnosis), Obesity
Conditions
Brief summary
Acute appendicitis is one of the most common surgical emergencies globally. While surgical removal of the appendix (appendectomy) is the definitive treatment, the optimal surgical approach-laparoscopic versus open-remains widely debated, particularly in obese patients. Obese individuals present unique surgical challenges due to increased abdominal wall thickness, which often necessitates larger skin incisions during open procedures, potentially increasing postoperative pain, wound healing times, and wound complications. This study aims to compare the postoperative outcomes of laparoscopic appendectomy versus standard open appendectomy in obese patients (BMI ≥ 30 kg/m²) presenting with acute appendicitis. Participants will be randomly assigned to undergo either open appendectomy or laparoscopic appendectomy. The primary outcomes evaluated will be the incidence of surgical site infections (including superficial wound infections and intra-abdominal abscesses) up to 30 days post-procedure and the total length of hospital stay (in days).
Interventions
PROCEDUREOpen Appendectomy
Open surgical removal of the appendix performed via a standard grid-iron incision under general anesthesia with standard prophylactic antibiotics.
PROCEDURELaparoscopic Appendectomy
Laparoscopic surgical removal of the appendix using a standard 3-port configuration (umbilical, left iliac fossa, and lower midline ports) under general anesthesia with standard prophylactic antibiotics.
Sponsors
University of Health Sciences Lahore
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
15 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
1. Obese patients with Body Mass Index (BMI) ≥ 30 kg/m². 2. Clinical diagnosis of acute appendicitis based on Alvarado score (history of right lower quadrant or periumbilical pain shifting to RLQ, nausea and/or vomiting, fever \> 38 °C, RLQ guarding and tenderness, and/or leukocytosis \> 10,000 cells/mL). 3. Age between 15 and 50 years. 4. Both male and female patients.
Exclusion criteria
1. Immunocompromised patients (e.g., HIV infection or current steroid therapy). 2. History of prior chemotherapy, radiotherapy, or recurrent infections. 3. History of drug or alcohol abuse. 4. Severe hepatic, renal, or cardiovascular dysfunction. 5. History of previous abdominal surgery. 6. Appendicular malignancy. 7. Pregnant women. 8. Preoperative findings indicating appendiceal perforation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Surgical Site Infection (SSI) | Up to 30 days postoperatively | Proportion of patients who develop a surgical site infection, defined as either superficial/deep wound infection (presence of purulent discharge, erythema, localized swelling, or requiring reopening) or intra-abdominal abscess (confirmed via ultrasound in patients presenting with abdominal pain, fever, or fullness) |
| Length of Hospital Stay | From day of surgery up to discharge (up to 30 days postoperatively) | The total number of days the patient remained in the hospital postoperatively until meeting discharge criteria (afebrile, tolerating a regular diet, and achieving good pain control). |
Outcome results
None listed