Laparoscopic management of appendicular lump

The surgical management of an appendicular lump remains controversial. With the revolution and advancement of laparoscopic instrumentation and technical learning curve, it is possible to remove an inflamed appendix in presence of lump. This retrospective study was performed between August 2018 and August 2019 in AIIMS Raipur, 86 patients were treated for appendicitis laparoscopically, in these 14 patients had appendicular lump at the time of admission. 12 patients (total 14; 2 patients were excluded) underwent laparoscopic intervention for appendicular lump. Average operative time were 90 minutes. Average post-operative hospital stay were 5 days. Post-operative complications were seen in 2 patients (surgical site infection). In histopathology report, appendicular inflammation suggestive of appendicitis were present in all operated cases. We conclude, early laparoscopic appendectomy confirms the diagnosis. It is safe and feasible in patients with appendicular lump. It reduces the treatment cost, early recovery and satisfactory overall outcome.

Ultrasonogram in Acute Appendicitis, A Surgeon’s Perspective: Original Article

Introduction: The diagnosis of acute appendicitis has essentially been clinical, but USG abdomen has been said to be highly accurate in diagnosing AA. The surgeon’s perspective may not always be the same. Materialsand methods: Appendectomy data of 106 patients from two hospitals of Kangra region was retrospectively analysed. The data was collected for age, sex, initial pre-operative diagnosis, USG findings, intra-operative findings, Histo-pathological examination (HPE) report, post operative hospital stay. Observations:It revealed a sensitivity of about 54% and specificity of 100% for diagnosing AA with the help of USG abdomen. AA was seen most commonly in males as compared to females. Mean age of presentation was 29.34 +/-14.4 years. Mean hospital stay was 3.68 +/-2.25 days. Most common initial preoperative diagnosis was AA (84%). Most common position of the appendix during surgery was retrocecal (53.7%). HPE report revealed AA in 105 patients. Conclusion:USG abdomen is often falsely assuring, leading to unnecessary delay in effectively managing a patient of AA further leading to increased complications. Only the clinically equivocal cases require further radiological investigations where CECT abdomen is the preferred investigation, but it should be used judiciously.

Management of Appendicular Lump: Early exploration Vs conservative management.

Background: Acute appendicitis is one of the most common acute surgical condition of the abdomen and appendicular lump is formed if treatment is delayed. It is encountered in 2 – 6%of patients. The traditional treatment of appendicular lump is conservative followed by delayed appendectomy. During conservative treatment 10-20% are not resolved and lead to gangrene or perforation followed by localized abscess or generalized peritonitis requiring early surgical intervention. Aims & Objective: A comparison of early exploration versus conservative management of appendicular lump. Material and Methods: A total of 632 patients were admitted in emergency and OPD of this hospital with diagnosis of appendicular lump and acute appendicitis over a period of three years, all were included in the study. All age groups and both sexes were included. The patients were divided randomly into two groups. Group I, early surgical exploration and group II, conservative approach with OCHSNER SHERREN, REGIME followed by interval appendectomy. Results: Out of 632 patients, only 62 patients who presented with appendicular lump were reviewed, suggesting 9.81% incidence. Maximum patients were found in age group of 21–30 years. Average duration of symptoms was 4 days. Two methods were adopted for the management of appendicular lump. The first group included 31 patients who were operated immediately after investigations and second group of 31 patients were managed conservatively followed by delayed appendectomy. In the first group mean hospitalization time was 4 days. Residual abscess, adhesive intestinal obstruction, failure of treatment and readmission were not observed. In the II group mean hospitalization time 10 days, more chances of residual abscess, adhesive intestinal obstruction, failure of treatment and readmissions were noted. Conclusion: Based on our finding, it can be concluded that early surgical exploration confirms the diagnosis and cures the problem, reduce the cost of management, shortens the convalescence and hospital stay with reasonably satisfactory outcome.