Abstract

APPENDICECTOMY BY OPEN AND LAPAROSCOPIC TECHNIQUE: AN OBSERVATIONAL STUDY

Dr. Purujit Choudhury* and Dr. Pooja S. Pai

ABSTRACT

Background: Appendectomy is one of the most common operations worldwide and appendicitis is a common indication. About 327,000 appendectomies used to performed during a year with a rate of 10.5 procedures per 10,000 population. Appendectomies accounted for 2.1% of all operating-room procedures in USA. The term appendectomy was coined by Reginald Fitz in 1886 (popularized in North America). And he first used the term appendicitis in the history of pathology of appendix. The first appendicectomy was performed by Claudius Amyand in December 6, 1735 when appendix was the content of hernia sac and presented with acute hemiscrotum. Approximately one-third of patients with appendicitis will experience a perforation of their appendix before their appendectomy. Open appendicectomy (OA) performed through the right lower quadrant incision was first described in 1894. It has become the standard treatment of choice for appendicitis of any type. In 1889 in New York City, Charles McBurney described the presentation and pathogenesis of appendicitis accurately and developed the teaching that an early appendectomy was the best treatment to avoid perforation and peritonitis. In 1890 Mc Burney postulated his famous muscle splitting incision. Laparoscopic appendicectomy (LA), first performed by Kurt Semm in September 13,1980, has gradually gained acceptance. However, there remains a continuining controversy in the literature regarding the most appropriate method of removing the inflamed appendix. Materials and Methods: An observational and comparative assessment of open and laparoscopic appendicectomy was executed at Gauhati Medical College from January, 2015 to December, 2019 in an elective surgical set up. Total 300 patients of recurrent appendicitis were diagnosed (by Clinical and investigations) in the general surgical OPD for this prospective study.198 patients were participated with their written consent. But 102 patients were not participated (not randomized).117 patients subjected for open and rest 81 patients were subjected for laparoscopic procedure. 17 out of 81 patients needed for conversion. Length of stay in hospital was the primary consideration, while operating time, postoperative morbidity, duration of convalescence and cosmesis in both the procedures were the secondary consideration including early resumption of routine work. Post-operative discomfort and narcotic requirement, post-operative wound infection, adhesion, incisional hernia, infertility are also of serious consideration.[25] Excluded from Lap and this study - Suspicious of malignancy; severe co-morbid illness like pulmonary, cardiac disorders; on radiotherapy or immune-compromised patients. These are said to be absolute contraindications. For laparoscopy. Moreover the patients with previous lower abdominal surgery; PID, endometriosis, pregnancy and difficult anatomy were also excluded from this study. These are said to be relative contraindications for lap.[25] Results: Equally short hospital stay in the two groups (average median 2 days though most patients could discharge after 1 day in laparoscopic group) were strongly observed during this study. The median time to return to normal activity (7 versus 10 days) and work (10 versus 16 days) was significantly shorter following laparoscopy. Laparoscopy was associated with fewer wound infections and improved cosmesis but the operating time was longer (60min versus 40min). Laparoscopy was associated with more intraperitoneal abscesses but adjusted for a greater number of gangrenous or sealed perforated appendices (these patients had repeated acute attack treated medically) in this group when chances of post-operative abscess is not negligible in comparison to open group, the difference failed to reach statistical significance. Conclusion: Though hospital stay was equally short in open and laparoscopic most patients could go home on 2nd post-operative day after laparoscopic appendicectomy. Laparoscopic appendicectomy was associated with fewer wound infections, faster recovery, earlier return to work, less post operative pain and improved cosmesis though slight and negligible higher intra-abdominal abscess and particularly those who gave history of earlier acute attack/multiple attack treated by conservative means.

Keywords: Laparoscopic (Lap) appendicectomy; Cosmesis; Converted to open (conversion), abscess, wound, early activity, pain.