Rajesh Kumar, Lal Shehbaz, Shua Nasir, Muhammad Abdul Wasey, Muhammad Ahmed Jangda, Zain Ali.
To compare and contrast different surgical procedures in treatment of complicated appendicitis in the adult population, at a tertiary care hospital in Karachi, Pakistan.
Pak J Surg Jan ;33(1):12-5.

Objective: The aim of our study is to compare and contrast primary closure and delayed primary closure in terms of its complications, post operative pain (patient satisfaction), and length of hospital stay in patients with complicated appendicitis at a tertiary care hospital in Karachi Pakistan. Method: The type of study is a randomized control trial conducted for a period of 2 years from April 2014 to April 2016, at a large tertiary care centre in Karachi Pakistan. The patient population consisted of all the patients of complicated appendicitis (as observed during the surgical procedure) who presented to us via emergency or outpatient department. All the patients underwent the appendectomy via the Lanz incision of grid iron incision. The patient demographics including age, marital status, gender, co-morbid conditions, symptoms etc were taken in a predesigned proforma. The surgical procedure was performed under general anesthesia, using a standard surgical technique of appendectomy giving special attention to minimal wound contamination, and making sure that the appendicular stump is not invaginated. Patient satisfaction was also recorded for all the patients on a scale from 0 to 100. Data was analyzed using SPSS version 23. Results: The patient population consisted of 120 patients (after calculating for a ratio of 1:5 cases of appendicitis to be complicated, and the total number of appendicitis patients initially was 400, of which 120 were selected, the rest were excluded as they did not have complicated appendicitis), divided into two groups using a random number generator, group P consisted of 60 patients who underwent primary closure for complicated appendicitis and group D consisted 60 patients who underwent delayed primary closure. The mean ages, gender distribution and other demographic variables were found to be similar in both the groups. Statistically significant differences were found between the length of hospital stay (lower of primary closure group) and patient satisfaction (higher in primary closure group) in the two groups. While no statistically significant difference was found when it comes to surgical wound infections in the two groups. Conclusion: According to the results of our study we conclude that complicated appendicitis treated with primary closure procedure is superior when compared with delayed primary closure, in terms of cost effectiveness and higher patient satisfaction with no significant increase in morbidity.

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