Post-surgical outcomes of laparoscopic appendectomy observed at BIRDEM hospital

Background and Objective: Currently, laparoscopic appendectomy (LA) is widely practiced for the management of acute appendicitis (AA). The application of laparoscopic technique for appendectomy is expanding very rapidly and now performed in almost all major cities and tertiary level hospitals. This study addressed to determine the outcomes of laparoscopic appendectomy in our surgical setup at Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM).Methodology: All admitted patients at BIRDEM hospital and clinically diagnosed as acute appendicitis considered eligible for the study. Based on clinical history relevant and routine biochemical investigations were done. A board of experienced surgeons selected the eligible cases for LA. The study continued from Sept 2014 to Sept 2016.Result: A total of 47 (M / F = 21 / 26) patients with acute appendicitis were admitted during this period. The mean (SD) age was 21 (±1.4) years in male and 19 (±1.7) years in female. The mean age of the total patients was 20 (±1.6) years. Eighty percent of the patients were of age 30 years or less. Per-operative laparoscopic findings revealed that five cases (10.6%) were misdiagnosed as appendicitis. Two (4.2%) cases were found to have other pathology and necessitated open appendectomy (OA). One was suspected for malignancy and other had appendicitis with adhesion. Overall, four important post-operative outcomes were observed: (a) post-operative pain was found reducing gradually and it fell below pain score 2 or even less after 30 hours; (b) port-site bleeding and infection were observed in 4.3% and 2.1%, respectively; (c) none had visceral bleeding or subcutaneous emphysema and (d) more than 80% were discharged within 72 hours.Conclusion: Most of the patients admitted with acute appendicitis were of younger age (<30 years). Though there was no comparative group undergoing open appendectomy (OA), it was apparent that laparoscopic approach was proved to have reduced pain, less complication and shorter hospital stay thus reducing the treatment cost. Thus, LA was found relatively safe and resilient procedure. An additional benefit of laparoscopy was that it revealed about 10% case were misdiagnosed as having appendicitis. Thus, this approach may be considered as a step forward in the treatment of appendicitis making easier to explore the abdominal cavity while keeping an option to perform an OA.IMC J Med Sci 2017; 11(1): 15-18

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Retrospective analysis of laparoscopic versus open appendectomy for the treatment of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20205355 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4045

Author(s):

Ritvik Resutra ◽

Haroon Salaria ◽

Rajive Gupta

Keyword(s):

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Open Appendectomy ◽

Laparoscopic Approach ◽

Routine Activity ◽

Laparoscopic Technique ◽

Time Duration ◽

Jammu And Kashmir ◽

Post Operative Pain ◽

General Surgeons

Background: Acute appendicitis is one of the most commonly encountered emergency by the general surgeons and appendectomy is the most common surgery performed in the world. Although open appendectomy is preferred by many surgeons, yet the laparoscopic approach is gradually replacing open surgery for treatment of acute appendicitis.Methods: A total of 400 patients of acute appendicitis were operated, 200 by laparoscopic appendectomy and 200 by open method by a single surgeon at various private hospitals in Jammu (Jammu and Kashmir), India over a period of three years from July 2017 to July 2020. The two groups were compared with respect to operative time, duration of hospital stay, post-operative pain, complication rate and time taken to resume routine activity and cosmetic satisfaction of the patients.Results: Results were found to be better with the laparoscopic technique. There was significantly less pain in the postoperative period with faster recovery, early resumption to work, reduced postoperative complications and better cosmetic satisfaction of the patients operated by the laparoscopic appendectomy technique as compared to open surgery.Conclusions: Laparoscopic appendectomy is safe and feasible technique in expert hands, for treatment of acute appendicitis with results comparable to the open appendectomy, with no obvious increase in complications and is definitely a procedure of choice for the management of acute appendicitis.

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Tactical approaches to the surgical treatment of patients with complicated forms of acute appendicitis and abdominal sepsis with a high risk of cardiopulmonary insufficiency

Modern medical technologies ◽

10.34287/mmt.2(41).2019.24 ◽

2019 ◽

Vol 41 part 2 (2) ◽

pp. 44-48

Author(s):

B. S. Zaporozhchenko ◽

Khasan Yakhia ◽

I. E. Borodaev ◽

V. N. Kachanov ◽

A. A. Vasiliev

Keyword(s):

High Risk ◽

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Standard Procedure ◽

Abdominal Cavity ◽

Open Appendectomy ◽

Abdominal Sepsis ◽

Group I ◽

Almost All ◽

Complicated Acute Appendicitis

Purpose of the study. To determine the feasibility and effectiveness of the laparoscopic method of treatment of patients with complicated forms of acute appendicitis. in patients with high risk of cardiopulmonary failure and to determine the indications for the use of various methods of laparoscopic appendectomy. Materials and methods. The result of treatment of 67 patients with acute appendage with high risky cardiopulmonary insufficiency. Of these, 10 patients (14,9%) were diagnosed with sepsis. The patients were divided into two groups: Group I: 29 (43,3%) patients with complicated acute appendicitis, with a high risk of cardiopulmonary insufficiency, who underwent open appendectomy. Open appendectomy was performed according to the standard procedure from the Volkovich-Dyakonov (Mac-Burney) incision in 19 (65,5%) patients, in 10 (34,5%) median laparotomy. Group II: 38 (56,7%) patients with complicated acute appendicitis who underwent laparoscopic appendectomy, and drainage of the abdominal cavity. Classical laparoscopic surgery with the imposition of pneumoperitoneum was performed in 20 (29,8%) patients and using the laparolifting method in 18 (26,9%) patients Results. 38 (56,7%) patients were operated on using laparoscopic techniques. During laparoscopic interventions, intraoperative revision and appendectomy were performed. This technique is absolutely safe, reliable and affordable in the performance of most surgeons. Conclusions. Laparoscopic appendectomy with complicated forms of acute appendicitis can be performed in almost all patients with acute appendicitis with a high risk of cardiopulmonary insufficiency. Keywords: acute appendicitis, complicated appendicitis, appendectomy, cardiopulmonary insufficiency, laparoscopy. sepsis.

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A retrospective study on laparoscopic appendectomy versus open appendectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20191127 ◽

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).

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LAPAROSCOPIC APPENDECTOMY BECOMES THE METHOD OF CHOICE IN THE TREATMENT OF ACUTE APPENDICITIS

Acta Medica Saliniana ◽

10.5457/ams.v37i2.12 ◽

2008 ◽

Vol 37 (2) ◽

pp. 143-146

Author(s):

Samir Delibegovic ◽

Ervin Matovic

Keyword(s):

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Open Appendectomy ◽

Laparoscopic Approach ◽

Usual Method ◽

Open Approach ◽

Frequent Complication ◽

Medical Centers ◽

Duration Of Operation ◽

Methods Of Treatment

Introduction: Laparoscopic appendectomy becomes a usual method in the treatment of acute appendicitis, although its advantage over open appendectomy has been proven. In Bosnia and Herzegovina, a few medical centers are introducing laparoscopic appendectomy as a method of treatment of acute appendicitis. In this study we want to compare different methods of treatment of acute appendicitis. Patients and Methods: During 20 months we have analyzed 498 patients operated due to acute appendicitis. We followed the duration of operation, total hospitalization stay, complications of surgical procedure and reasons of conversion in patients operated by laparoscopic approach. Results: The duration of operation was 96 minutes in the group operated by open approach and 107 minutes in the group operated by laparoscopic approach. Total hospitalization stay was 3.9. days in the group operated by open approach and 2.3. days in the group operated by laparoscopic approach. The most frequent complication in the group operated by open approach was infection of the operative wound (56/452) and ileus (5/452), and in the group operated by laparosocopic approach ileus (1/46) was the most frequent complication. Conclusion: The patients operated by laparoscopic approach have fewer risk of wound infection, and the hospital stay is shorter. With the increase of surgeon’s experience this method of treatment of acute appendicitis will become a method of choice.

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645 An EGS-Led Service for Acute Appendicitis Enhances Surgical Training Whilst Improving Outcomes for Patients: Results of A 6-Month Audit

British Journal of Surgery ◽

10.1093/bjs/znab134.463 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Issa ◽

L A Sommereux ◽

J Osuji ◽

R Meredith ◽

M H Muhammed ◽

...

Keyword(s):

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Open Appendectomy ◽

Clinical Findings ◽

Negative Appendectomy ◽

Complication Rates ◽

Emergency Unit ◽

Open Conversion ◽

Operative Outcomes ◽

Operative Findings

Abstract Introduction Appendicitis is common &treatment by appendectomy is usually undertaken. Variations in diagnostics &imaging are accompanied by high negative appendectomy rates (NAR) of around 20%. This study evaluated the outcomes of appendectomy in a dedicated Surgical Emergency Unit. Method All patients undergoing emergency appendectomy between 1stSept 2019&29thFeb 2020 were identified. Demographics, clinical findings, pre-operative investigations, intra-operative findings &post-operative outcomes were recorded. Results There were 192 patients (102 [53.1%] female;90 [46.9%] male). Median age was 36 years(range 8-80)with 25 below 14.Some 58.3% underwent imaging (ultrasound 33.5%; CT 32.5%). Laparoscopic appendectomy (LA) was performed in 84.4% of cases with 11.4% open; conversion from laparoscopic to open was only 4.2%. Some 56% paediatric patients had open appendectomy & 44% laparoscopic with no conversions. Trainees were the sole or first operators in 63% of cases. NAR was just 5.7%. Some 21(10.9%) patients were readmitted within 30 days of which 8 had a collection; all were treated conservatively. Conclusions Accurate clinical diagnosis & selective use of imaging in a dedicated EGS unit optimizes outcomes for appendectomy with low NAR & low complication rates. Appendectomy is effectively undertaken by trainees. LA is safely performed in children.

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Laparoscopic appendectomy for acute appendicitis: an observational study from a peripheral hospital with limited facilities in Kashmir, India

International Surgery Journal ◽

10.18203/2349-2902.isj20200810 ◽

2020 ◽

Vol 7 (3) ◽

pp. 717

Author(s):

Hakeem Vaqar Ahmed ◽

Majid Mushtaque

Keyword(s):

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Low Cost ◽

Laparoscopic Approach ◽

Suture Materials ◽

Conversion To Open Surgery ◽

Peripheral Hospital ◽

Operative Complications ◽

The Mean ◽

Level Hospital

Background: Appendectomy is one of the most commonly performed procedures in abdominal surgery and the laparoscopic approach is gradually replacing the conventional laparotomy for acute appendicitis.Methods: A total of 108 patients with acute appendicitis who underwent laparoscopic appendectomy at JLNM Hospital Srinagar over a period of five years were evaluated in terms of feasibility and safety of the procedure at the District level hospital. It was an observational study.Results: The age of the patient ranged between 16 and 43 years, with 68 males and 40 females. Most (76.85%) of the patients had un-ruptured inflamed appendix. The mean operative time was 43 minutes with no intra-operative complications. Two patients required conversion to open surgery. Mean duration of hospital stay was 1.7 days. Eight patients had post-operative complications which were managed conservatively.Conclusions: Laparoscopic appendectomy is safe and feasible in expert hands, and can be done using low cost, readily available basic laparoscopic instruments and suture materials at hospitals with limited facilities.

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Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0011 ◽

2019 ◽

Vol 101 (4) ◽

pp. 235-248 ◽

Cited By ~ 6

Author(s):

M Frountzas ◽

C Nikolaou ◽

K Stergios ◽

K Kontzoglou ◽

K Toutouzas ◽

...

Keyword(s):

Clinical Practice ◽

Acute Appendicitis ◽

Pregnant Women ◽

Laparoscopic Appendectomy ◽

Fixed Effects ◽

Meta Analysis ◽

Open Appendectomy ◽

Fetal Loss ◽

Laparoscopic Approach ◽

Increased Risk

IntroductionAcute appendicitis is a common and serious situation during pregnancy, because of the increased risk of fetal loss and perforation in the third trimester, as well as a diagnostic difficulty. During recent years laparoscopic approach has been introduced to clinical practice with encouraging results. The purpose of this meta-analysis is to compare the surgical and obstetrical outcomes between laparoscopic and open appendectomy during pregnancy.Materials and methodsMEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on postoperative outcomes between laparoscopic and open appendectomy during pregnancy. The random effects model (DerSimonian–Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel–Haenszel) model was implemented.ResultsTwenty-one studies that enrolled 6276 pregnant women are included in the present meta-analysis. Of these women, 1963 underwent laparoscopic appendectomy and 4313 underwent an open appendectomy. Women who underwent laparoscopic appendectomy demonstrated an increase in fetal loss risk, while neonates of women that underwent open appendectomy presented decreased Apgar score at five minutes after birth. All the rest outcomes were similar between the two groups. The time that each study took place seemed to affect the comparison of birth weight and postoperative hospital stay between the two groups.ConclusionLaparoscopic appendectomy seems to be a relatively safe therapeutic option in pregnancy when it is indicated. Thus, it should be implemented in clinical practice, always considering the experience of the surgeon in such procedures. Nevertheless, the need of new studies to enhance this statement remains crucial.

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The peculiarity of appendectomy of patients with high risk of cardiopulmonary insufficiency

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(3)-11 ◽

2018 ◽

Vol 22 (3) ◽

pp. 456-459

Author(s):

B.S. Zaporozhchenko ◽

Hasan Yahya ◽

I.I. Borodaev ◽

V.N. Kachanov ◽

O.A. Vasyliev

Keyword(s):

High Risk ◽

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Abdominal Cavity ◽

Open Appendectomy ◽

Pulmonary Insufficiency ◽

Results Of Treatment ◽

Cardiopulmonary Failure ◽

Group 2 ◽

Group 1

Acute appendicitis (AA) ranks first in the frequency of emergence of urgent surgical diseases in hospitals in Ukraine. In recent years, laparoscopic appendectomy has become one of the “gold standards” of surgery. Of particular interest in this group of patients is a gasless and with small amount of gas laparoscopy, in which the endosurgical space in the abdominal cavity is created with the help of endolifts, in which the abdominal wall is raised mechanically, without creating a pneumoperitoneum. Objective — to determine the feasibility and effectiveness of the use of various techniques for laparoscopic appendectomy of patients with a high risk of cardiopulmonary insufficiency. All patients with АA were divided into 2 groups: Group 1 — 72 patients with АA diagnosis, with a high risk of cardiopulmonary failure, who underwent open appendectomy; Group 2 — 85 patients with АA diagnosis with a high risk of cardiopulmonary failure, who underwent laparoscopic appendectomy with pneumoperitoneum and using laparolifting method of patients. The laparolifting was performed with the help of the device developed by the clinic for laparolifting on Zaporozhchenko-Kolodii. When analyzing the results of treatment of patients with IІ group, it should be noted that laparoscopic appendectomy, especially with laparolifting, may be the operation of choice in the treatment of patients with acute appendicitis. This technique is absolutely safe, reliable and affordable in the implementation of most surgeons. So, laparoscopic appendectomy can be performed in virtually all patients with acute appendicitis with high risk of cardio-pulmonary insufficiency with the avoidance of postoperative complications.

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Transumbilical Laparoscopic-Assisted Appendectomy in the Treatment of Acute Uncomplicated Appendicitis in Children

Gastroenterology Research and Practice ◽

10.1155/2015/949162 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Carmine Noviello ◽

Mercedes Romano ◽

Ascanio Martino ◽

Giovanni Cobellis

Keyword(s):

Acute Appendicitis ◽

Operative Time ◽

Open Appendectomy ◽

Laparoscopic Technique ◽

Diffuse Peritonitis ◽

Histopathologic Examination ◽

Appendiceal Mass ◽

Uncomplicated Appendicitis ◽

The Mean ◽

Laparoscopic Assisted

Transumbilical laparoscopic-assisted appendectomy (TULAA) is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis) and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA). All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA) was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males) with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years). Primary OA was performed in 144 cases. In 300 patients a transumbilical laparoscopic-assisted approach was performed. TULAA was completed in 252 patients. Conversion to OA was performed in 45 patients and to LA in 3. Conversion was related to the impossibility to adequately expose the appendix in 47 patients and bleeding in 1. The mean operative time for TULAA was 42 minutes. Histopathologic examination of the appendix removed by TULAA showed a phlegmonous/gangrenous type in 92.8% of cases. Among the 252 TULAA there were 11 cases of umbilical wound infection. TULAA is a feasible and effective procedure for uncomplicated appendicitis in children. It combines the advantages of open and laparoscopic technique (low operative time, low complications rate, and excellent cosmetic results).

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Single-Port Laparoscopic Appendectomy Performing by Emergency Operation: An Intervention Study in Vietnam

Trends in Medical Sciences ◽

10.5812/tms.118897 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Duc Minh Pham ◽

Vu Anh Pham ◽

Mai Tuyet Vi ◽

Linh Van Pham

Keyword(s):

Laparoscopic Surgery ◽

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Single Port ◽

White Blood Cells ◽

Emergency Operation ◽

Clinical History ◽

Control Group ◽

Duration Of Symptoms ◽

The Mean

Background: Appendectomy is one of the most commonly performed surgical procedures of the abdominal area. One of the recent innovations is single-port laparoscopic surgery (SPLS), which can insert multiple ports through a proprietary device with multiple channels. An incision is sited in the umbilicus to result in no visible scar. Objectives: The study aimed to evaluate the results of the treatment of acute appendicitis by applying single-port laparoscopic surgery. Methods: A clinical single-port laparoscopic appendectomy intervention of 122 patients, with the absence of a control group, was carried out by a sole surgeon at the Hue University of Medicine and Pharmacy Hospital, Hue, Vietnam, from August 2013 to December 2017. Research parameters included clinical history, physical examination, laboratory test, ultrasound imaging, intraoperative characteristics, and surgical outcomes. Results: We included 122 patients (64 males and 58 females) who met the inclusion criteria. The mean age was 31.28 ± 13.51 years (range, 16 - 73 years). The average BMI was 20.4 ± 1.39 kg/m2. All patients had abdominal pain, and the average duration of symptoms was 17.39 ± 5.41 hours (range, 6 - 31 hours). Five patients had a history of abdominal surgery. The mean diameter of appendicitis in ultrasound was 8.8 mm (range, 6 - 15 mm). Moreover, 89.3% of patients had an increase in white blood cells. The difficult location of appendicitis was 1.6% under the liver and 20.5% in the retrocecal region. In addition, 18.0% of retroperitoneal appendicitis and 6.6% of appendicitis were under cecalserosa. The mean operative time was 40.19 ± 14.67 mins (range, 23 - 150 min). Two cases (1.6%) required additional trocar insertion. Three cases (2.5%) had wound infection and no other complications. The median hospital stay was 3.64 ± 1.72 days (range, 2 - 13 days). Conclusions: Single port laparoscopic surgery is the safe and effective treatment of acute appendicitis. This technique may be feasible for acute appendicitis with a difficult location.

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