scholarly journals Predictors of Difficult Laparoscopic Appendectomy in Acute Appendicitis

2021 ◽  
Vol 17 (3) ◽  
pp. 234-240
Author(s):  
Mukesh Karki ◽  
Narayan Belbase
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
Duration Of Symptoms ◽  
Tertiary Center ◽  
Male Sex ◽  
Potential Factors

IntroductionAcute appendicitis is the most common surgical emergency of the abdomen and appendectomy is one of the most frequently performed surgical procedures. Laparoscopic appendectomy is one of the commonest surgical procedure in most of the tertiary center and is being an effective alternative to open appendectomy. Despite continuing evolution in laparoscopic appendectomy, this procedure continue to carry the risk of conversion to openappendectomy. The objective was to analyze the factor, identify the predictors for difficult laparoscopic appendectomy. MethodsThe study was conducted in College of Medical Sciences, Bharatpur. All patients who underwent laparoscopic appendectomy from 1st January 2020 to 30th December 2020 were included in the study after taking written informed consent. A detailed performa was developed to record informationregarding patient history, physical examination, laboratory parameters, ultrasonography findings, CT findings and intra-operative details. Laparoscopic appendectomy done in more than 120 minutes, converted into open due to difficulty in surgery and not due to complications, severe adhesions were considered to be a case of difficult appendectomy. ResultsIn our study total 94 patients underwent laparoscopic appendectomy among which 16 (17.02%) cases had difficult appendectomy. The incidence of difficult appendectomy was higher among older age group, male sex, long duration of symptoms, high white blood cell count, difficult anatomy, pre existing co-morbid condition, extreme findings on computed tomography and ultrasonography (USG). Operating time, anaesthetic time, and duration of hospital stay werelonger after difficult appendectomy.  ConclusionsIdentifying the potential factors for conversion preoperatively may assist the surgeons in making decisions concerning the management of patients with appendicitis and in the judicious use of laparoscopic appendectomy. From our study we found that independent predictors for difficult appendectomy are old age, male sex, prolonged duration of symptoms, high white blood cellcount, higher body mass index (BMI), extreme inflammation in computed tomography scan and ultrasonography. Proceeding directly with open appendectomy under these circumstances may reduce operative time, reduce hospital stay and morbidity. Keywords: Acute appendicitis, Laparoscopic appendectomy, Open appendectomy, Conversion 

scholarly journals Comparison of laparoscopic appendectomy versus open appendectomy in acute appendicitis in obese diabetic patients

2020 ◽  
Vol 10 (3) ◽  
pp. 145-148
Author(s):  
Mohammuddunnobi ◽  
Tasnuva Jahan ◽  
Abdullah Al Amin
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Wound Infection ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
World Health ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Post Operation

Background: Acute appendicitis (AC) is a common surgical problem requiring emergency hospitalization for urgent appendectomy. In case of diabetic patients, the incidence of developing acute appendicitis including its complications like abscess, gangrene and perforation is higher than non-diabetic. Day by day, laparoscopic appendectomy is having an improved outcome in non-diabetic and non-obese patients. The aim of this study was to compare the outcomes of laparoscopic appendectomy versus open appendectomy in acute appendicitis of obese diabetic patients. Methods: A comparative study was carried out in a tertiary care hospital in Dhaka City. Hospitalized obese diabetic patients with a diagnosis of acute appendicitis, who underwent appendectomy, were considered as study population. Obesity was defined as body mass index (BMI) greater than 30 kg/m2 according to World Health Organization and American Obesity Association guidelines. Patients were divided into two groups according to type of appendectomy; 50 patients by laparoscopic appendectomy as group LA and 50 patients by open appendectomy as group OA. Results: Most patients were obese I (30.0-34.9 kg/m2) in group LA and OA (92.0% and 86.0%, respectively, p<0.05). Uncontrolled diabetes mellitus was detected in most of the patients of both group LA (96.0%) and OA (98.0%). Mean operation time, mean duration of post-operation ileus, mean hospital stay and post-operation complications were less in group LA than group OA which is statistically significant (p< 0.05). No patient developed wound infection after laparoscopic appendectomy; whereas, 8.0% patients had wound infection in open appendectomy (p<0.05). Conclusion: In this study, laparoscopic appendectomy had good outcome over its open counterpart regarding shorter operating time, hospital stay, less wound infection, postoperative pain and time to return to usual activities. Birdem Med J 2020; 10(3): 145-148

scholarly journals A Prospective Study on Laparoscopic Intervention in Acute Appendicitis in a Teritiary Care Hospital, North Andhra

2021 ◽  
Vol 8 (24) ◽  
pp. 2034-2039
Author(s):  
Janni Laxman ◽  
Patnala Mohan Patro ◽  
Janardana Rao K.V.
Keyword(s):  
Acute Appendicitis ◽  
Prospective Study ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
Late Presentation ◽  
Age Group ◽  
A Prospective Study

BACKGROUND We wanted to determine the various pre-operative and intra-operative factors responsible for conversion to open technique of appendectomy and compare the clinical outcomes of hospital-stay and operating time between open appendectomy and laparoscopic appendectomy. METHODS Patients presented to General surgery Department of GITAM Institute of Medical Sciences and Research with features suggestive of acute appendicitis from September 2017 to November 2019 were included in this study. This is a prospective study which included a total of 100 patients. These patients were divided into two groups of 50 each. One group of patients with early presentation with symptoms of less than 3 days of duration, another group with late presentation of 3 or more days of onset of symptoms were included. In this study we wanted to compare the clinical outcomes of hospital stay and operating time between open appendectomy and laparoscopic appendectomy. RESULTS In this study, majority of patients belong to age group 20 - 44 years who had delayed presentation to hospital, in contrast to patients who presented early involved the age group of 21 – 30 years. In this study, pain abdomen was the commonest symptom (100 %) with which patient presented. The other symptoms were nausea/vomiting (72 %), fever (63 %). Seven patients presented with diarrhea. CONCLUSIONS Our data suggest that laparoscopic appendectomy is associated with improved clinical outcomes even in patients who had late presentation. KEYWORDS Appendicitis, Laparoscopic, Gangrenous

Changes in Incidence and Management of Acute Appendicitis in Children—A Population-Based Study in the Period 2000–2015

2020 ◽  
Author(s):  
Grith Laerkholm Hansen ◽  
Jakob Kleif ◽  
Christian Jakobsen ◽  
Anders Paerregaard
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Pediatric Population ◽  
Open Appendectomy ◽  
Postoperative Mortality ◽  
Population Based ◽  
Postoperative Hospital Stay ◽  
Population Based Study ◽  
Registration System

Abstract Introduction Recent studies suggest that the epidemiology and management of appendicitis have changed during the last decades. The purpose of this population-based study was to examine this in the pediatric population in Denmark. Materials and Methods Data were retrieved from the Danish National Patient Registry, the Danish Civil Registration System, and the Statbank Denmark. Patients aged 0 to 17 years diagnosed with appendicitis and appendectomized during the period 2000 to 2015 were included. The primary outcome was the annual incidences of appendicitis. Secondary outcomes were the annual percent of patients with appendicitis having a laparoscopic appendectomy, delay from admission to surgery, length of postoperative hospital stay, and 30-day postoperative mortality. Results A total of 24,046 pediatric cases of appendicitis were identified. The annual incidence steadily declined until 2008 (–29%, all ages) and then remained stable. The surgical approach of choice changed from being open appendectomy in 2000 (97%) to laparoscopic appendectomy in 2015 (94%). Simultaneously, the duration of postoperative hospital stay declined from 41 hours (median) to 17 hours. Delay from admission until surgery did not change during the period. Only one child died within the 30-day postoperative period. Conclusion In accordance with other recent studies from Western countries, we found significant changes in the incidence of acute appendicitis including a decline in all age groups except those below 5 years of age, a shift toward laparoscopic appendectomy, and decreasing time spent in the hospital during the years 2000 to 2015.

scholarly journals A retrospective study on laparoscopic appendectomy versus open appendectomy

2019 ◽  
Vol 6 (4) ◽  
pp. 1144
Author(s):  
P. Senthil Kumar ◽  
S. Edwin Kin’s Raj ◽  
Saranya Nagalingam
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Open Appendectomy ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Daily Activities ◽  
Early Return

Background: Appendectomy is the most common surgical procedure performed in emergency surgery. Open appendectomy is the “gold standard” for the treatment of acute appendicitis. Laparoscopic appendectomy though widely practiced has not gained universal approval. Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy in a retrospective study.Methods: The study was done as a retrospective study among 387 patients diagnosed with appendicitis for a period of 18 months in the Dept of General Surgery. All patients included were 16 years and above and followed up for 3 weeks. In this study, 130 patients diagnosed as acute appendicitis - underwent open appendectomy and 257 patients diagnosed as sub-acute cases of appendicitis - underwent laparoscopic appendectomy. These two groups (open & laparoscopic) were compared for operative time, length of hospital stay, postoperative pain, complication rate, early return to normal activity.Results: Laparoscopic appendectomy was associated with a shorter hospital stay (around 4.5 days), with a less need for analgesia and with an early return to daily activities (around 11.5 days). Operative time was significantly shorter in the open group (35 mins), when compared with laparoscopic group (around 59 mins). Total number of complications was less in the Laparoscopic group with a significantly lower incidence of post-op pain and complications.Conclusions: The laparoscopic approach is a safe and efficient operative procedure and it provides clinically beneficial advantages over open appendectomy (including shorter hospital stay, an early return to daily activities and less post-op complications).

scholarly journals Characteristics and Outcomes of Acute Appendicitis Cases During the COVID-19 Pandemic

2020 ◽  
Author(s):  
Murat Başer ◽  
Mehmet Kağan Katar
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Open Surgery ◽  
Open Appendectomy ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Complication Rates ◽  
Duration Of Symptoms ◽  
Conversion To Open Surgery ◽  
Group B

Abstract Background: Our aim in this study was to investigate the effects of the COVID-19 pandemic on acute appendicitis cases.Methods: This study was designed as a single-center, retrospective, and observational study. The patients were divided into three groups relative to the date of the first COVID-19 case in Turkey, which was March 10, 2020 (Group A: before the pandemic; Group B: pandemic period; Group C: the same period one year before the pandemic). A total of 413 patients were included in the study.Results: In terms of treatment modality, the rate of open appendectomy was significantly higher in group B (p<0.001). Rates of conversion to open surgery, as well as rates of complicated appendicitis were also significantly higher in group B (p=0.027, p=0.024, respectively). While there was no difference between the groups in terms of preoperative hospitalization duration (p=0.102), it was found that the duration of symptoms, operation time, and postoperative length of hospital stay were significantly higher in Group B (p<0.001, p=0.011, p=0.001, respectively). In addition, the complication rate in group B (8.9%) was also significantly higher than in the other two groups (p=0.023).Conclusion: We found that the rate of open surgery, the rate of conversion of laparoscopic surgery to open surgery, complication rates, mean operation time, and postoperative hospital stay were significantly higher in acute appendicitis patients that underwent surgery during the COVID-19 pandemic period. We believe that the main reason for this negative outcome is the late admission of the patients to the hospital.

scholarly journals A comparative study of laparoscopic appendectomy versus open appendectomy

2019 ◽  
Vol 7 (1) ◽  
pp. 138
Author(s):  
Reina Khadilkar ◽  
Ashwini Anil Panditrao ◽  
Ramteja Inturi
Keyword(s):  
Acute Appendicitis ◽  
Comparative Study ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Research Centre ◽  
Total Leukocyte Count ◽  
College Hospital ◽  
Early Return ◽  
Duration Of Surgery

Background: Obstruction of appendiceal lumen resulting in acute appendicitis is diagnosed by clinical examination, supported by raised neutrophil count, computed tomography and/or ultrasonography.Appendectomy one of the most commonly done surgeries is the standard line of management for acute appendicitis. Trend is towards greater utilization of laparoscopic appendectomy despite lack of consensus on superiority of laparoscopic procedure, hence imperative to prove scientifically the effectiveness of the two methods. The aim of the present study was a comparative study of laparoscopic appendectomy versus open appendectomy.Methods: A prospective cohort study of 100 cases of acute appendicitis above 16 years of age with no co morbidities was carried out in Dr. D. Y. Patil Medical College, Hospital and Research Centre from July 2017 to September 2019.Results: Mean age was 28.82 years, 64 (64%) males and 36 (36%) females, pain in abdomen (100%) being most common complaint followed by fever (77%) with positive correlation with severity of appendicitis (Alvarado score) and with total leukocyte count. Mean duration of surgery and hospital stay in laparoscopic appendectomy was lesser than open and difference was statistically highly significant (p=0.000). No difference in pain score observed. Retrocaecal (58%) was the most common position, slightly higher rate of complications in open appendectomy, no conversion of laparoscopic to open. Subjective level of satisfaction score (0-10) in laparoscopic appendectomy was higher than in open and difference was statistically highly significant (p=0.000).Conclusions: Laparoscopic appendectomy had advantages like better cosmesis, shorter duration of procedure and hospital stay, fewer post-operative complications and early return to work with disadvantage of steep learning curve, while open appendectomy, does not require special instruments, and is performed under direct three-dimensional vision.

scholarly journals COMPLICATED APPENDICITIS;

2017 ◽  
Vol 24 (01) ◽  
pp. 82-88
Author(s):  
Awais Shuja ◽  
Professor M Ramzan ◽  
Nadia Sharif
Keyword(s):  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
Complicated Appendicitis ◽  
Open Approach ◽  
Number Of Patients ◽  
Analgesia Requirement ◽  
Group A ◽  
The Mean

Appendectomy is the most common surgical procedure performed in surgicalemergency. The advent of minimal invasive surgery has massively influenced the field of surgery.Laparoscopic surgery might offer clinical benefits in perforated and complicated appendicitis.Objective: To compare laparoscopic appendectomy and open appendectomy as treatment ofcomplicated appendicitis in terms of mean requirement of post-operative analgesia, operativetime and hospital stay. Study design: Randomized control trial. Setting: All subjects for thestudy were recruited from Department of Surgery, Independent University Hospital, Faisalabad.Duration: The duration of study was of 6 months duration from February 2012 to august 2012.Results: In this study the divided into two groups, group A for open appendectomy (OA)and group B for Laparoscopic Appendectomy (LA). Both groups had 43 patients each. Theoperating time for open appendectomy group A had mean operating time 37.21 minutes .Thehospital stay in OA group was 2.63 days. The mean dosage of analgesia requirement was 258mg of diclofenac. The operating time for open appendectomy group A had mean operatingtime 39.16 minutes. The hospital stay in OA group was 2.95 days. The mean dosage of was258.14 mg of diclofenac. Conclusion: Our study concludes that both approaches laparoscopicand open approach have proved to be similar in terms of post-operative hospital stay, operatingtime and analgesia requirement. Where as LA is superior in terms of cosmesis and surgicalsite infection. Further studies with more number of patients are recommended to asscess thebenefits of laparoscopic approach in complicated appendicitis.

scholarly journals TWO-PORT LAPAROSCOPIC APPENDECTOMY IS MORE BENEFECIAL THAN OPEN APPENDECTOMY IN EARLY ACUTE APPENDICITIS

2017 ◽  
Vol 52 (2) ◽  
pp. 131
Author(s):  
Vicky S Budipramana
Keyword(s):  
Acute Appendicitis ◽  
Wound Infection ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
Operation Time ◽  
T Test ◽  
Small Incision ◽  
Post Operative Pain ◽  
Significant Difference

Open appendectomy has already commonly been performed to treat acute appendicitis, but the relatively more painful and longer incision scar becomes a cosmetical problem. Two port laparoscopic appendectomy can be performed safely, less painful and leaving only two small incision scars. The aim of the study was to evaluate the benefit of two-port laparoscopic appendectomy and that of with open appendectomy in the case of early acute appendicitis. An observational study was conducted from 2012 to 2014; to compare the operating time, post operative pain and wound infection in early acute appendicitis, performed with two-port laparoscopic appendectomy and with open appendectomy. The statistical analysis in this study uses t-test. There were 114 patients (73 men and 41 women) divided into two groups based on the choice made by the patients themselves. The number of samples performed with two-port laparoscopic appendectomy was 64 and that with open appendectomy was 46. Four patients were excluded from this study. In analysis using t-test, we found that the two-port laparoscopic appendectomy was more beneficial than open appendectomy. There was a significant difference between the two groups, the length of operation time was 37.22 minute in two-port laparoscopic appendectomy and 43.83 minute in open appendectomy (p=0.00), VAS pain score was 1.58 in two-port laparoscopic appendectomy and 2.30 in open appendectomy (p=0.00) and no post operative wound infection in both two groups. The conclusion is two-port laparoscopic appendectomy technique is faster and less painful and the same risk of wound infection than open appendectomy in early acute appendicitis.

scholarly journals Comparative study of single incision versus conventional three port laparoscopic appendectomy

2018 ◽  
Vol 5 (12) ◽  
pp. 3852 ◽  
Author(s):  
Sahil Rometra ◽  
Rahil Rometra ◽  
Neeraj Koul ◽  
R. K. Chrungoo
Keyword(s):  
Laparoscopic Surgery ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Single Incision ◽  
Open Appendectomy ◽  
Single Incision Laparoscopic Surgery ◽  
Abdominal Incision ◽  
Significant Difference

Background: Appendicitis is primarily a disease of adolescents and young adults with a peak incidence in the second and third decades of life. Appendectomy for appendicitis is the most commonly performed emergency operation in the world.For more than a century, open appendectomy remained the gold standard for the treatment of acute appendicitis.  Laparoscopic surgery has become popular universally during the last couple of decades.   Efforts are still being made to decrease abdominal incision and visible scars after laparoscopy.  Single incision laparoscopic surgery (SILS) is a new innovation allowing minimal access surgery to be performed through a single umbilical incision.Methods: It was a prospective study carried out on 50 patients diagnosed as acute appendicitis. They were divided into two groups of 25 each. One group underwent Conventional Laparoscopic Appendectomy (CLA) and other group underwent Single Incision Laparoscopic Surgery (SILS).  Results were compared with regard to mean operative time,   complications, post-operative pain and discomfort (vas score at 12 hours), post-operative morbidity, duration of hospital stay and condition at discharge and cosmesis.Results: There was no statistically significant difference between the two groups with respect to the parameters like postoperative pain, hospital stay and complication profile. However, operative time for SILS appendectomy were found to be significantly higher compared to conventional group.Conclusions: Single incision laparoscopic appendectomy using standard laparoscopic instruments is safe and effective, feasible surgery with better cosmetic results.

Laparoscopic Appendectomy Provides Better Outcomes than Open Appendectomy in Elderly Patients

2011 ◽  
Vol 77 (4) ◽  
pp. 466-470 ◽  
Author(s):  
Shih-Chi Wu ◽  
Yu-Chun Wang ◽  
Chih-Yuan Fu ◽  
Ray-Jade Chen ◽  
Hung-Chang Huang ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Elderly Patients ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
Intraoperative Blood Loss ◽  
Postoperative Course ◽  
Ventilator Dependence ◽  
Hospital Days

The incidence of acute appendicitis in elderly patients is increasing due to prolonged life span. The associated morbidity and mortality related to perforation of acute appendicitis continue to present challenges to physicians. The role of laparoscopic appendectomy is still controversial. This study aimed to compare the postoperative outcomes of elderly patients who received either a laparoscopic or an open appendectomy. We retrospectively reviewed charts of patients with acute appendicitis between January 2005 and February 2009. Elderly patients who received laparoscopic or open appendectomies were enrolled. The demographics, preoperative condition, operating time, intraoperative blood loss, and postoperative course were analyzed. A total of 150 patients were enrolled in this study. On average, patients who received a laparoscopic appendectomy had fewer hospital days and lower rates of postoperative ventilator dependence than patients who received an open appendectomy. In the management of elderly patients with acute appendicitis, laparoscopic appendectomy provides better outcomes than open appendectomy.

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