A comparative study of RIPASA score and Modified Alvarado score in the diagnosis of acute appendicitis- A valuable tool for decision making

Background-Acute appendicitis is the most common cause of an acute abdomen requiring emergency surgery.The routine diagnosis of appendicitis is based purely on clinical history and examination combined with laboratory investigations.Our study is an attempt to compare both scoring systems (MODIFIEDALVARADO and RIPASA) in diagnosis of acute appendicitis and correlating both the scoring systems with the intraoperative and histopathological findings. Objectives-To correlate the diagnostic scoring systems (Modified Alvarado and RIPASA) with intraoperative and histopathological findings in cases of acute appendicitis. To compare RIPASA and Modified Alvarado scoring systems. Methods-A Hospital basedProspective study was conducted at Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Mandya from August 2020 to May 2021. Patients presenting to the General surgery department and emergency in our hospital with RIF pain was included in this study. Total Sample size of 138 was studied.Data was collected from the patient’s records. For all patients RIPASA and Modified Alvarado scoring was done. Modified Alvarado score contains 7 parameters where as RIPASA score contains 16 parameters and Operative and histopathological findings were compared. Results- Out of the 138 patients, 113 patients were <39.9 years of age and 25 patients were ≥40 years. Percentage of 81.9% and 18.1% respectively.92 were male and 46 were females.Right iliac fossa pain was present in all the 138 patients in the study group. Fischer’s exact test has been applied and Modified Alvarado scoring system diagnosis correlates well with the histopathological diagnosis (p-value is <0.0398).Sensitivity of the scoring system in the study is 72.31% and specificity comes out to be 75%.The mean score for normal appendix, healed appendix, healing appendicitis and acute appendicitis is 5.00, 6.777, 7.125 and 8.414 respectively. There has been increase in mean modified Alvarado score with increase in histopathological severity. Conclusion-By comparing both scoring systems, RIPASA scoring system found out to be an easy and reliable diagnostic tool for the diagnosis of acute appendicitis and RIPASA scoring system is better than Modified Alvarado scoring system for the diagnosis of acute appendicitis in our study population

Outcome of open cholecystectomy and laparoscopic cholecystectomy- A comparative study

Background: Cholelithiasis, which continues to be one of the most common digestive disorders encountered, was traditionally being dealt by conventional or open cholecystectomy. With the introduction of laparoscopic cholecystectomy, the surgical community witnessed a revolution in basic ideology and the importance of minimal access surgery has suddenly impacted. Materials and Methods: 50 patients admitted at Adichunchanagiri institute of medical science with a diagnosis of calculous cholecystitis underwent open / laparoscopic cholecystectomy. 25patients constituted each group. Results: The duration of Laparoscopic cholecystectomy was significantly more than for open cholecystectomy (median 95 min in LC and 80 min in OC). One patients of laparoscopic group required conversion to open procedure. The drains were required in less number of patients of Laparoscopic cholecystectomy group and for less number of days. No Wound infection was seen in Laparoscopic cholecystectomy patient when compared to 5 in OC patients. The Visual Analogue Scale for pain in the post op period was significantly less for LC patients compared to OC patients (median 7 in OC group as compared to 4 in LC group) . The duration of hospital stay was significantly longer for OC group than for LC group (Mean of 7.84 days versus 3.68 days respectively). The cosmetic result was significantly better in LC group than OC group ( Mean cosmetic score of 4.72 in LC group and 3.44 in OC group. Median score was 5 for LC group and 3 for OC group). Conclusion: Laparoscopic cholecystectomy is Superior to Open cholecystectomy. Therefore, laparoscopic cholecystectomy is considered the “Gold Standard” procedure for cholecystectomy