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•Funding: None
•Conict of interest: None
•Ethical approval: Obtained from IRC (Institutional
Review Committee)
INTRODUCTION
•Reginald Heber Fitz - coined 'appendicitis', which he correctly called
'inflammation in the connective tissue about the caecum'.1
•Most common etiology of acute abdomen, generally requiring urgent surgical
intervention, with a lifetime incidence between 7 and 9%.2
•Despite advances in modern radiographic imaging and laboratory
investigations, the diagnosis of appendicitis remains essentially a clinical
diagnosis.3
•In developing country like Nepal, with limited health resources, the trend of LA
is emerging. Hence, this study was conducted to determine difference in clinical
outcome and cost analysis between LA and OA.
METHODS
Setting: RCT conducted in the Department of Surgery, B.P.K.I.H.S, a tertiary care hospital
in Eastern Nepal, over a period of one year.
Study population and participants: All adult clinically diagnosed cases of acute
appendicitis fulfilling inclusion and exclusion criteria.
I) Inclusion Criteria:
1. All clinically diagnosed case of acute appendicitis and/or
2. MANTRELS Score >7
II) Exclusion Criteria
1. Appendicular lump, abscess, perforation / generalized peritonitis
2. Pregnancy
3. Age <10 or >50
4. Patients not giving informed consent
Sample Size:
This study considered a complication proportion of LA and OA as 0.029 and 0.132
respectively. (Ref: BMC Surgery journal 2014 volume 14, issue 14 ,Minutolo V et al
(2014)
Now using the difference between two proportion formula for a RCT study as below
Where
n= number of sample
Zα/2=1.96 at 95% confidence interval (C.I)
Zβ=0.842 at 80% power (P)
According to literature review, 95% CI and 80% P has been used for sample size estimation
p=1/2(p1+p2); q=1-p; p1= the complication rate of LA; p2=complication rate of OA; q1=1-
p1; q2=1-p2.
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MANTRELS SCORE
SYMPTOM SCORE
Migratory RIF pain 1
Anorexia 1
Nausea & Vomiting 1
SIGNS
Tenderness (RIF) 2
Rebound tenderness 1
Elevated temperature 1
LABORATORY
Leucocytosis 2
Shift to left 1
TOTAL 10
Score: 1 to 4-discharge/watchful waiting; 5 to 6-observation/waiting; 7 to 10-
surgery
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