Author(s): Ramesh Kumar Bhuta1
In 1983, the selected cases of acute appendicitis management by laparoscopic appendectomy has gained increasing favour in the past decade, which was initially described by Semm. Less postoperative pain, shorter hospital stay, early return to work and better cosmesis are the benefits of LA, which is why it is considered as a minimal access surgery. These benefits of laparoscopic appendectomy have made this surgery attractive. Because of the advantage compared with open surgery, LA has been widely accepted, but not for management of all cases. In complicated cases, LA has complication rate and conversion rate led to questioning its safety. Due to lack of skill, LA has been quoted in literature as a contributing factor to high complication rate. In complicated cases of appendicitis, currently, there is no consensus regarding safety and feasibility of LA. The most common indications for emergent surgical intervention in children is acute appendicitis. It is treated by laparoscopic appendicitis, but its role in management is controversial in children. The management of complicated and uncomplicated cases of appendicitis by LA needs clarification in its safety issues. This study will suggest if LA can be used as a standard care for both complicated and uncomplicated cases of acute appendicitis.
MATERIALS AND METHODS
This study is a prospective study in which data was collected from August 2013 to November 2016 at Apollo Institute of Medical Sciences and Research, Hyderabad. An ethics clearance was obtained from institutional ethical committee. Some special investigations were done to diagnose the appendicitis. Inclusion Criteria- All patients with a preoperative diagnosis of acute appendicitis and who were performed an emergency LA. Exclusion Criteria- All patients with incidental appendectomies and interval appendectomies. Demographic data such as age and sex were collected.
A total of 500 patients were reviewed and 300 were included in the study. All these patients were offered LA. The age group between 23-85 years had majority of males (112) and females (50). Males contributed majority of the total population (65%). 200 were excluded due to incidental appendectomy, operated as elective case, managed nonoperatively and insufficient data. Out of 300 cases who were offered laparoscopic appendectomy, 270 cases were successful. In the four quadrant pus, the conversion rate was higher. Out of 300 cases, 95 cases were complicated and 105 were uncomplicated. In the complicated cases, majority had four quadrant pus (55), localised pus (35) and appendix mass (5). Relooks were 5%, intraoperative complications and postoperative complications were 1% and 4%. Morbidity and mortality were 2% and 1%.
This approach is possible in carefully selected patients and with appropriate basic laparoscopic skills and there was a positive outcome found in this study when LA was used in both complicated and uncomplicated cases of acute appendicitis.