No./ /Surgery/VIMS/08-09.

Dated:15.11.2008

Place:Bellary

From,

Dr VIDYADHAR KINHAL

The Prof and Head of the Department,

Department of General Surgery

VIMS, Bellary.

To,

The Registrar,

RajivGandhiUniversity of Health Sciences,

Bangalore.

THROUGH PROPER CHANNEL

Respected Sir,

As per the regulations of the University for Registration of Dissertation topic the following Post Graduate student in General Surgery ( In-service ) has been allotted the dissertation topic as follows by the Official Registration committee of all qualified and eligible Guides of the Department of General Surgery.

NAME / TOPIC / GUIDE
DR. BASA REDDYN
Post Graduate in
M S General Surgery
(In-service )
VIMS, Bellary. / “A COMPARITIVE STUDY OF LAPAROSCOPIC APPENDICECTOMY AND OPEN APPENEDICECTOMY AT VIMS HOSPITAL BELLARY” / DR. KASA SOMASEKHAR
Professor,
Dept of General Surgery
VIMS, Bellary.

Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG student at an early date.

Thanking you, Yours faithfully,

Signature of the guide:

DR. KASA SOMASEKHAR Dr VIDYADHAR KINHAL

Professor Professor and HOD

Dept of General Surgery Dept of General Surgery

VIMS, Bellary. VIMS, Bellary.

No./ /Surgery/VIMS/08-09.

From,

DR. BASA REDDYN Dated:15.11.2008

PG in General Surgery ( In-service) Place :Bellary:

VIMS , Bellary.

To,

The Principal,

Vijayanagar Institute of Medical Sciences,

Bellary.

THROUGH PROPER CHANNEL

Respected sir,

Subject: Acceptance of registration and forwarding of my dissertation topic.

With reference to the above subject, I, the undersigned studying Post Graduate course in General Surgery ( In-service ) have been allotted the dissertation topic “A COMPARITIVE STUDY OF LAPAROSCOPIC APPENDICECTOMY AND OPEN APPENEDICECTOMY AT VIMS HOSPITAL BELLARY”, under the guidance of DR. KASA SOMASEKHAR, PROFESSOR, Department of General Surgery, VIMS, Bellary.

I request you to kindly forward the dissertation topic in the prescribed form to the University for Approval.

Thanking you,

Yours faithfully,

Signature of the guide: DR. BASA REDDY N

PG in General Surgery, ( In-service )

VIMS, Bellary.

DR. KASA SOMASEKHAR

PROFESSOR,

Dept. of General Surgery ,

VIMS, Bellary.

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 / Name and address of the candidate / DR BASA REDDY.N.
ANJANA NILAYA, PATEL NAGAR,
BELLARY.
2 / Name of the institution / VIJAYANAGAR INSTITUTE OF MEDICAL SCIENCES , BELLARY.
3 / Course of study and subject / M.S. GENERAL SURGERY.
4 / Date of admission to course / JUNE 18TH 2008.
5 / Title of the Topic / “A COMPARITIVE STUDY OF LAPAROSCOPIC APPENDICECTOMY AND OPEN APPENEDICECTOMY AT VIMS HOSPITAL BELLARY ”
6. Brief resume of the intended work
6.1 / Need for the study:
The introduction of laparoscopic surgery has dramatically changed the field of surgery. With improvements in the equipment and increasing clinical experience it is now possible to perform almost any kind of procedure under laparoscopic visualization.
Although more than a century has elapsed since McBurney first performed open appendicectomy [1], this procedure remains the treatment of choice for acute appendicitis for most surgeons.
At present, although there is no consensus regarding the superiority of the laparoscopic approach over the conventional technique, there is trend towards greater utilization of laparoscopic appendicectomy.
In the present study, we aim to compare the laparoscopic approach and the conventional technique in the treatment of acute appendicitis, using prospectively collected data from patients subjected to appendicectomy between November 2008 and October 2010.
6.2 / Review of Literature
In 1983, Semm performed the first laparoscopic appendicectomy [2]. Ever since then, the efficiency and superiority of laparoscopic approach compared to the open technique has been the subject of much debate.
The idea of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities, and better cosmetic outcome has made laparoscopic surgery for acute appendicitis very attractive.
In Kurtz RJ, Heimann TM conducted a comparative study of open and laparoscopic treatment of acute appendicitis. Seven hundred fifty-eight patients underwent appendicectomy for acute appendicitis during the 5-year study period. Two hundred seventy-one (36%) had open appendectomy and 487 (64%) had laparoscopic appendicectomy. They concluded that Differences in outcome between open and laparoscopic appendicectomy are minor. In this study, more difficult cases with gangrenous appendicitis were more likely to require open appendicectomy whereas milder forms of appendicitis, especially in women, were more likely to be treated by laparoscopy. Savings from the slightly shorter hospital stay after laparoscopic appendicectomy are offset by the higher surgical cost of the laparoscopic equipment[3].
In another study, A prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis conducted by Milewczyk M, Michalik M, Ciesielski M, had concluded that, on the basis of the conducted study, it may be assumed that laparoscopic appendicectomy is a safe procedure, and that postoperative morbidity is comparable with that for a conventional operation. There was less postoperative pain and shorter recovery time after laparoscopic surgery than after the open procedure[4].
However, several retrospective studies[5-6], several randomized trials[7-8] and meta-analyses[9-10] comparing laparoscopic with open appendicectomy have provided conflicting results.
6.3 / Aim of the study:
Study is to compare the results or outcome of 50 cases of laparoscopic appendicectomy and 50 cases of open appendicectomy in patients with acute or recurrent appendicitis.
Objectives of the Study:
To compare regarding.
1.Duration of surgery.
2. Incidence of complications.(intraoperative & post-operative)
3.Incidence of conversion to open appedicectomy & reasons for conversion.
4.Post-operative pain.
5.Duration of Hospital stay.
6.Time taken to resume routine work.
7. Materials and Methods
7.1 / Source of data:
This prospective study will be conducted on patients admitted to VIMS hospital with symptoms suggestive of acute or recurrent appendicitis from Nov 2008 to Oct 2010.
Type of study: Prospective study.
Sample size: Fifty patients of laproscopic appendicectomy and fifty patients of open
appendicectomy
7.2 / Method of collection of data(including sampling procedure if any)
INCLUSION CRITERIA
  1. Patients with a clinical picture consistent with the diagnosis of acute appendicitis.
  2. Patients with a clinical picture consistent with the diagnosis of recurrent appendicitis.
3. Age > 10 yrs
4. Both sexes
EXCLUSION CRITERIA
1. Age > 70 years
2. Patients unfit for General Anaesthesia
3. Generalized peritonitis
4. Appendicular mass or abscess
5. Pregnancy
6. Appendicitis with visceral pathology which needs open surgery
7.3 / Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly.
YES,
-Hb%, TC, DC, ESR
-RBS
-Blood Urea , Serum Creatinine, Blood grouping
-Ultrasound Abdomen
-ECG. Chest X-ray.
-CT abdomen wherever indicated.
7.4 / Has Ethical clearance been obtained from your institution in case of 7.3
Yes,
Obtained from VIMS institutional ethical committee of VIMS, Bellary
8. / List of References:
1 McBurney C. IV. The Incision Made in the Abdominal Wall in Cases of Appendicitis, with a Description of a New Method of Operating. Ann Surg 1894; 20: 38-43.
2.Semm K. Endoscopic appendicectomy. Endoscopy 1983; 15: 59-64.
3.Kurtz RJ, Heimann TMComparison of open and laparoscopic treatment of acute appendicitis.Am J Surg. 2001 Sep;182(3):211-4..
4.Milewczyk M, Michalik M, Ciesielski MA prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis. : Surg Endosc. 2003 Jul;17(7):1023-8.
5.Wullstein C, Barkhausen S, Gross E. Results of laparoscopic vs. conventional appendicectomy in complicated appendicitis. Dis Colon Rectum 2001; 44: 1700-1705
6. Towfigh S, Chen F, Mason R, Katkhouda N, Chan L, Berne T. Laparoscopic appendicectomy significantly reduces length of stay for perforated appendicitis. Surg Endosc 2006; 20: 495-499.
7.Milewczyk M, Michalik M, Ciesielski M. A prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis. Surg Endosc 2003; 17: 1023-1028.
8. Olmi S, Magnone S, Bertolini A, Croce E. Laparoscopic versus open appendicectomy in acute appendicitis: a randomized prospective study. Surg Endosc 2005; 19: 1193-1195.
9.Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendicectomy: a metaanalysis. J Am Coll Surg 1998; 186: 545-553.
10.TempleLK, LitwinDE, McLeod RS. A meta-analysis of laparoscopic versus open appendicectomy in patients suspected of having acute appendicitis. Can J Surg 1999; 42: 377-383
9 / Signature of the candidate
10 / Remarks of the Guide
11 / Name and Designation of Guide / DR. KASA SOMASEKHAR
PROFESSOR
DEPARTMENT OF GENERAL SURGERY,
VIMS, BELLARY.
Signature of the Guide
12 / Head of the Department / DR. VIDYADHAR KINHAL
PROF AND HEAD OF THE DEPARTMENT,
DEPARTMAENT OF GENERAL SURGERY,
VIMS, BELLARY.
Signature
13 / Remarks of the Principal
Signature