Laparoscopic Clipping Versus Extracorporeal Ligation in Complicated Appendicitis Upper Egypt Overview

Study Overview
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Brief Summary
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The investigators aim to compare between laparoscopic clipping and extracorporeal ligation in complicated appendicitis regarding safety, efficacy, operative time, postoperative outcome, hospital stay and complications.

Detailed Description
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Appendectomy has become one of the most commonly performed emergency abdominal operations since it's description by McBurney in the 1890s. Since laparoscopic appendectomy was first described in 1983, there is an increase in the general trend towards performing this surgery using laparoscopy instead of open technique as this approach shows better pain score, lesser use of analgesics, less operative complications, better post operative recovery, less hospital stay and rapid return to normal work. There are many methods for securing the base of the appendix, some of which are expensive others are not available or technically demanding. In this study the investigators aim to compare between extracorporeal ligation and clipping techniques regarding feasibility, safety, efficacy, operative time, postoperative outcome and complications especially in complicated appendicitis. AS management of complicated appendicitis laparoscopically is possible, secure and can lead to a little occurrence of infectious complications, fewer post-operative pain, quick revival and improve cosmesis so the investigators will do a prospective clinical trial comparative study between two common techniques to determine the best one in management of complicated cases.

Official Title
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Laparoscopic Clipping Versus Extracorporeal Ligation in Complicated Appendicitis Upper Egypt Overview, Prospective Randomized Comparative Study

Conditions
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Appendicitis

Intervention / Treatment
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* Procedure: Laparoscopic appendectomy using clipping.
* Procedure: Laparoscopic appendectomy using extracorporeal ligation to secure the base of the appendix.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Acute complicated appendicitis. Perforated appendicitis (diagnosed intraoperatively) Patients who will undergo laparoscopic appendectomy. Exclusion Criteria: Patients with straight forward appendectomy. Patients who are not fit for laparoscopic appendectomy.

Ages Eligible for Study
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Minimum Age: 7 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants will be divided randomly into two groups, in the first group the investigators will use clipping in securing the base of the appendix but in other groups investigators will use extracorporeal ligation.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Laparoscopic clipping appendectomy<br>This group will undergo laparoscopic clipping of the base of the appendix during laparoscopic appendectomy. | Procedure: Laparoscopic appendectomy using clipping.<br>* Laparoscopic appendectomy using clipping to secure the base of the appendix.<br>|
| Active Comparator: Laparoscopic extracorporeal ligation appendectomy<br>This group will undergo laparoscopic extracorporeal ligation of the base of the appendix during laparoscopic appendectomy. | Procedure: Laparoscopic appendectomy using extracorporeal ligation to secure the base of the appendix.<br>* Laparoscopic appendectomy using extracorporeal ligation to secure the base of the appendix.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Operative time | Time of the total procedure. | After procedure completion, an average of 1 hour. | 
| Postoperative complications | All patients will be observed postoperatively for occurrence of complications as leakage, pelvic abscess, wound infection | Through study completion, an average of 1 year. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital stay | Duration of hospital stay | Through the patient's hospital stay, an average of 1 week. |