Laparoscopic Appendicectomy in All Benign Pathologies of the Appendix: A retrospective study

Abstract

Background: Acute appendicitis is one of the most common surgical conditions and urgent appendicectomyis recommended and practiced for more than 100 years1,2. McBurney's appendicectomy by an open muscle splitting technique was the gold standard surgical procedure1. Laparoscopic appendicectomy (LA) is gaining popularity since 1987. But this new technique has a longer learning curve and requires expensive equipment (high capital investments).The aim of this study was to ascertain the generalizability of this novel procedure when appendicectomy is indicated.

Method: This study was done over a period of six years in BIRDEM. Between March 2010 to February 2016, all consecutive cases of Laparoscopic appendicectomy was selected for the study. Operation was performed under general anaesthesia using standard three puncture technique. After the procedure all resected specimen was sent for histopathology.

Result: Laparoscopicappendicectomy was attempted in 113 patients, 57(50.4%) female and 56(49.6%) males. Mean age of the patients were 35.2 years and ranged from 5 to 65 years. Laparoscopicappendicectomy was performed in emergency basis in 102(90%) due to acute appendicitis, gangrenous appendix, perforated appendix or appendicular abscess. Eleven patients (10%) underwent elective surgery due to interval appendicectomy, mucocole of appendix, incidental appendicectomy. The most common indication for laparoscopic appendicectomy in this series was acute appendicitis (62%). Only one patient (<1%) had to be converted to an open appendicectomy due to injury to caecal wall. There was no peri-operative mortality in this series. Hundred and five patients (93%) weredischarged in lessthan 24 hours of surgery and seven (6%) within 48 hours of surgery after removal of intrabdominal drain. Follow-up period was one month to two years.

Conclusion: All the advantages of laparoscopy are well applied in laparoscopic appendicectomy. Morbidity, mortality and conversion rate came down to a minimum with time and experience. Hence laparoscopic appendicectomy should be the procedure of choice when appendicectomy in indicated.

Bangladesh Crit Care J September 2018; 6(2): 80-83