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Background: Appendicular mass consists of matted loops of bowel and omentum adherent to the adjacent inflamed appendix. Laparoscopic approach adds diagnostic value and allows visualization of entire abdominal viscera facilitating better and safer dissection.Methods: This is an observational prospective study done in patients presenting to Gandhi Hospital’s surgical department with incidentally detected appendicular mass on laparoscopy from August 2016 to August 2018.Results: Maximum cases belong to adolescent age group (13 out of 30). Majority of cases are male patients (24 out of 30). Each surgery took around 1 hour. No intraoperative complications occurred in 23 patients. Difficult adhesiolysis experienced in 5 patients. Serosal bowel injury occurred in 1 patient. Orals were delayed where intraoperative dissection was prolonged or difficult. Majority of patients were discharged after 3 days.Conclusions: With immediate operative management of appendicular mass presenting in early stages of inflammation, dissection can be safely proceeded with and appendicectomy can be safely performed eliminating the need for second hospitalization and risk of recurrence. The incidence of intra-operative and post-operative complications is low making laparoscopic appendicectomy in early appendicular mass a safe and feasible treatment option.
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Background: Appendicectomy is one of the most common surgical procedures performed in emergency surgery. Despite this, there is still lack of consensus about the most appropriate technique for appendicectomy. In this longitudinal analysis, we aimed to compare the outcomes of laparoscopic appendicectomy (LA) and the conventional technique or open appendicectomy (OA) in the treatment of acute appendicitis.Methods: A non-randomized longitudinal comparative study was conducted in NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India. From November 2017 to October 2019, 53 patients underwent OA and 59 underwent LA, making a total number of patients included in this study to be 112 (n). The two groups were compared for operative time, length of hospital stay, postoperative pain, post-operative ileus and complication rate.Results: Laparoscopic appendicectomy was associated with a shorter hospital stay (4.34±1.37 days in LA and 5.09±1.71 days in OA, p<0.01), with a lower post operative pain score [VAS] (2.93±0.80 in LA and 4.62±0.92 in OA, p<0.001). Operative time was shorter in the open group (42.70±12.05 min in OA and 43.39±16.59 in LA). Complications were lesser in the LA group with a significantly lower incidence of wound infection (3.4% in LA and 13.2% in OA).Conclusions: Laparoscopic approach is safe and efficient in appendicectomy and it provides clinically advantages over open method (shorter hospital stays, lower post op pain, early food tolerance, earlier return to work and lesser wound infection) against only marginally longer operative time.
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Background: Open appendectomy has been the gold standard for the treatment of acute appendicitis since its introduction by Charles Mc Burney in 1889.The introduction of laparoscopic surgery has dramatically changed the field of surgery. Various studies showed conflicting results about the superiority of laparoscopic approach over open for treatment of acute appendicitis. Present study is conducted to determine any possible benefits of the laparoscopic approach over open surgery.Methods: The study was conducted in Dr. V. M. Government Medical College and hospital located in Solapur (Maharashtra) from September 2017 to September 2019. It is a prospective comparative study. Patients were randomly divided into 2 groups alternately where group A and B were operated by conventional and laparoscopic techniques respectively and their outcomes were compared.Results: Mean age of patients in open and laparoscopic appendicectomy group was 29.67 years and 31 years respectively. Post-operative pain, wound infection and hospital stay was significantly more in open group as compared to laparoscopic group (p<0.05).Conclusions: From the results of our study we conclude that laparoscopic appendicectomy has superior results as compared to open appendicectomy.
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Background: The most essential component of laparoscopic appendectomy is the closure of appendicular stump. Failure of which can result in catastrophic complications including intra-abdominal and surgical site infections and rarely faecal fistula. The aim of this study was to verify the effectiveness of preformed catgut endoloop and extracorporeal polyglactin 910 for appendicular stump closure.Methods: This prospective study was carried out in 64 patients. We compared patient demographics, duration of surgery, intra and post-operative complications, hospital stay and cost of surgery between the two groups.Results: A total of sixty-four patients were finally included in the analysis, catgut group (n=34), polyglactin 910 group (n=30). The demographics between the two groups were similar. The mean age in catgut group was 23.94 years and polyglactin 910 groups was 23.33 years. Mean duration of surgery was 41.6 and 41.8 minutes in catgut and endoloop group respectively. Mean hospital stay was 3 days. There was no mortality but complications were seen in 6 patients. However, there was no statistical significance in between the two groups with any of the parameters studied.Conclusions: Multiple studies have demonstrated safety and effectiveness of various techniques of appendicular stump. The use of extracorporeal single polyglactin 910 extracorporeal suture knot is safe and cost-effective technique for closure of appendicular stump in rural and resource poor regions.
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Introduction: Appendicitis is the most common causeof surgical abdomen in all age groups with a lifetime riskof 6%. The role of laparoscopic appendicectomy remainscontroversial as many researchers have suggested thatoverall morbidity is primarily a function of the degree of theappendicitis rather than the operative approach. The presentstudy was designed to compare the outcome of laparoscopicappendicectomy versus open appendicectomy in a tertiarycare hospital.Material and methods: This was a randomized controlledstudy on 100 cases of acute appendicitis operated inRohilkhand Medical College, Bareilly in a period of one year.The patients were randomly assigned to two groups of 50 eachoperated by open and three port laparoscopic surgery.Results: Abdominal pain (100%) was the commonestpresenting complaint. Retrocaecal anatomical position (76%in open, 70% in lap. appendicectomy) of the appendix wasthe commonest operative finding. Wound infection rate (8%)was insignificantly higher in open appendicectomy. Therewas significantly less operative time, postoperative painbetter cosmesis and early return to normal daily activity inlaparoscopic as compared to open appendicectomy.Conclusion: Laparoscopic appendicectomy is better ascompared to open appendicectomy in terms of post-operativecomplications, post-operative pain, hospital stay, early returnto normal activity, and subjective cosmesis.
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Background: Vermiform appendix, though a vestigial organ in a human without much purpose forms. The most common cause of acute abdomen and also the most common surgical intervention by a general surgeon. Open appendicectomy has been practiced for more than 130 years all over the world with a good outcome. But laparoscopic appendicectomy grabbed the attention of not only surgeons but also the patients after the pioneering efforts of Kurt Semm in 1982. Although our hospital has been practicing open appendicectomy for many decades laparoscopic appendicectomy was introduced in recent past. The aim of the study: Aim was to compare the laparoscopic against open appendicectomy based on the following parameters: Post-surgical pain, Return of bowel sounds, Return to eating, Post-operative complications, Post-operative antibiotics duration. Materials and methods: Patients who come to the outpatient and emergency clinic of the Department of General Surgery, KAPV Government Medical College between January 2016 and June 2017. Among the patients who had come to General Surgery OP clinic and emergency clinic, after thorough examination patients with features of appendicitis were included as subjects for study. Patients were allotted as subjects in each group by simple random sampling. Blood investigation, Chest X-ray, X-ray abdomen, USG abdomen, CT abdomen were done and assessment obtained for Yeganathan Rajappan, Anandan Kanthan, Mahalakshmi Ashok Kumar, Manimaran Thangavelu. A comparative study between laparoscopic and open appendicectomy in KAPV Government Medical College, Trichy. IAIM, 2019; 6(3): 259- 265. Page 260 those patients after sufficient resuscitation with iv fluids, antibiotics, and analgesics. Patients who were diagnosed with appendicitis were explained about the diagnosis, need for surgery, surgical procedure planned and its complications and then informed written consent obtained. Results: In our study, mean operation duration for LA was 61.54 min and 51.62 min for open appendicectomy. The p-value was 0.022 which was significant statistically. Operation duration was short in laparoscopic appendicectomy. Our study also shows less pain for lap group which was calculated using a pain rating scale, with mean in OA as 3.16 and 2.32 in LA group and the p-value was p-0.000 which was statistically significant. Diet was started earlier in lap appendicectomy group in our study. Postoperative complication and postoperative antibiotics duration were less in LA group as like in earlier studies. Conclusion: Laparoscopic appendicectomy is better than open appendectomy in selected patients with acute or recurrent appendicitis.
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Background: Appendicitis is sufficiently common that appendicectomy is the most frequently performed urgent abdominal surgery. Despite extraordinary advances in modern radiographic imaging and diagnostic laboratory investigations, the diagnosis of appendicitis remains essentially a clinical diagnosis. Aim of the study: To determine the outcome of laparoscopic appendicectomy compared to open appendectomy and to rule out the clinical outcome between two major procedures. Materials and methods: This comparative study was done in Government Medical College, Omandurar Government Estate in 2016 to 2018. A total of 75 patients' files that underwent surgery within the study period were perused. Thirty-two patients (42.7%) underwent laparoscopic surgery (LA) and 43 patients (57.3%) underwent open appendicectomy (OA). The relevant data was then extracted from the case notes using a pre-designed proforma questionnaire. Results: There were a total of 44 male patients and 31 female patients in the study. All patients undergoing either LA or OA presented with right iliac fossa pain. Patients who presented with nausea undergoing LA were 53.13% while 31.11% undergoing OA presented with nausea. Vomiting was present in 18.75% of patients undergoing LA while 44.44% of the patients undergoing OA had vomiting. Fever was noted in patients undergoing OA (15.55%). Majority of patients had symptoms duration of between one day and one week. Those with symptoms durations of less than one day were 9.4% for LA group and 23.3% for the OA group. Urea and electrolytes were done in 93.8% of A. Sagaya Inba Sekar, Anandi Andappan. Comparative study on laparoscopic appendicectomy versus open appendicectomy in a tertiary hospital at Chennai. IAIM, 2019; 6(3): 182-187. Page 183 patients undergoing LA and 69.8% of those undergoing OA. Abdominal ultrasound was performed in 40.6% of patients undergoing LA and 18.6% of a patient undergoing OA. Urinalysis and microscopy were performed in 6.3% of patients undergoing LA and 9.5% of patients undergoing OA. Wound sepsis occurred in 6.7% of patients undergoing OA. Miscarriage occurred in 1 patient undergoing OA. Only one patient in LA developed complication due to ileus. Conclusion: Laparoscopic appendicectomy takes longer to perform our institution than open appendicectomy. Postoperative complications are lower with laparoscopic appendicectomy when compared with open appendicectomy.
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<p><b>INTRODUCTION</b>We conducted a single-centre, prospective randomised clinical trial to investigate the analgesic efficacy of transversus abdominis plane (TAP) block in adult patients undergoing laparoscopic appendicectomy.</p><p><b>METHODS</b>Patients undergoing urgent laparoscopic appendicectomy under general anaesthesia alone (control group) and general anaesthesia supplemented by TAP block (TAP intervention group) were compared. All patients received a multimodal analgesia regime, which included postoperative morphine via a patient-controlled analgesia device. The primary endpoints were morphine consumption at 12 hours and 24 hours postoperatively. Secondary endpoints included pain scores, incidence of nausea and vomiting, and time to hospital discharge. A total of 58 patients were recruited, with 29 patients in each group.</p><p><b>RESULTS</b>Mean postoperative morphine consumption at 12 hours (control group: 11.45 ± 7.64 mg, TAP intervention group: 9.79 ± 8.09 mg; p = 0.4264) and 24 hours (control group: 13.38 ± 8.72 mg, TAP intervention group: 11.31 ± 8.66 mg; p = 0.3686) for the control and TAP intervention groups were not statistically different. Secondary outcomes were also not different between the two groups. Length of stay in the post-anaesthesia care unit was significantly shorter for the TAP intervention group, with a trend toward faster hospital discharge being observed.</p><p><b>CONCLUSION</b>TAP block, a regional anaesthetic procedure performed immediately prior to skin incision for laparoscopic appendicectomy, did not significantly improve postoperative analgesia outcomes.</p>
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Background: Laparoscopic appendicectomy has become the preferred procedure for treating appendicitis in last 10-15 years. The reasons are laparoscopy provides a better visualization of the operating field, pelvic organs like ovaries can be visualized in female patients, causes less postoperative pain, needs lesser hospital stay, gives faster recovery and most importantly a better cosmetic scar. The standard laparoscopic appendicectomy needs 3 ports to be introduced into the abdomen. Many modifications were introduced recently like SILS (Single port/Incision Laparoscopic Surgery), NOTES (Natural Orifice Transluminal Endoscopic Surgery), TUSPLA (Trans Umbilical Single Port Laparoscopic Appendicectomy), etc. with an intention to decrease the postoperative pain, decrease the hospital stay and give better cosmetic outcome. We present a series of twelve cases of laparoscopic appendicectomy performed using two ports and a needle instead of third port, which when performed successfully gives a better cosmetic outcome as the third port is avoided. Aims and objectives: The aim of the study was to assess the feasibility of two ports needle assisted laparoscopic appendicectomy. Materials and methods: This was an observational study done on a total number of 42 laparoscopic appendicectomies performed by a single operating team between June 2015 and May 2016. Two port appendicectomy were attempted. But, the procedure could be successfully performed in only 12 cases because of various reasons. Results: Out of 42 cases TPNAA could be performed successfully in 12 procedures. 30 cases needed regular 3 port procedure because of various reasons. Conclusion: TPNAA is a modification of regular three port appendicectomy and is a simple procedure and gives a better cosmetic outcome which can be performed in selected cases.
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Introduction: Laparoscopic Appendicectomy is a gold standard of surgical management of Appendicitis. Our study is an Experience of first 60 cases of Laparoscopic Appendectomy at newly opened GCS Medical College and Hospital, Ahmedabad. Objectives: To study Laparoscopic Appendicectomy with respect to operative time, patient comfort, post-operative complications, hospital stay and cost effectiveness. Methodology: A non randomized study of first 60 patients underwent Laparoscopic Appendicectomy from December 2012 to August 2014 in surgery department of newly opened Teaching Hospital in Ahmedabad, Gujarat, India. Result: Mean operative time was 40 minutes; average post-operative hospital stay was 3 days, post-operative complication rate was 8.33% including URTI, Fever and Wound Infection. None of the patient required conversion to open surgery. Conclusion: Results of Laparoscopic Appendicectomy in our Institute were comparable with referenced studies and International data. It is also cost effective. Recommendation: A newly established surgical training Institute must focus on performing basic Laparoscopic surgeries such as Lap Appendicectomy on routine basis. the procedure were identified as the main predictors of surgical site infections.
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La cirugía laparoscópica se enfoca hacia el desarrollo de técnicas cada vez menos invasivas. Con el avance tecnológico es posible introducir a la cavidad abdominal múltiples instrumentos a través de un mismo puerto. Describimos la técnica de la apendicectomía laparoscópica mediante la utilización de tres puertos de acceso a través de la misma incisión umbilical, utilizando instrumental convencional, en un paciente de 33 años de edad, con dolor abdominal de 18 horas de evolución. La intervención se realizó de forma exitosa, sin complicaciones intra ni posoperatorias. El paciente egresó a las 12 horas de operado. La apendicectomía en pacientes adultos mediante una sola incisión es una técnica segura y fácilmente reproducible cuando existe entrenamiento adecuado(AU)
The laparoscopic surgery is focused on the development of increasingly less invasive techniques. The technological advances have made it possible to introduce many medical instruments into the abdominal cavity through the same port. Here is the description of the laparoscopic appendicectomy by using three ports of access through the same umbilical incision to introduce the conventional instruments in a 33 years-old patient who had suffered abdominal pain for 18 hours. The surgery was successful, neither intraoperative nor postoperative complications occurred. The patient was discharged after 12 hours of operation. Appendicectomy in adults by using just a single incision is a safe, easily reproducible technique when appropriate training is present(AU)