Laparoscopic appendectomy for acute appendicitis: is this a feasible option for developing countries?

The role of laparoscopic appendectomy is still not well defined in the literature. This study was conducted to evaluate the feasibility of laparoscopic appendectomy at a university hospital in a developing country. Patients undergoing laparoscopic appendectomy [LA] from August 2002 to August 2006 were identified. For each case, a control was selected from patients undergoing open appendectomy [OA] during the same year by systematic sampling. The groups were compared in terms of duration of surgery, requirement of narcotic analgesia, length of hospital stay, postoperative complications and the overall cost for each patient. A total of 68 patients underwent laparoscopic appendectomy during the study period. Median duration of surgery was 82 minutes in LA group and 70 minutes in OA group [P < 0.001]. Forty-five patients in LA group and 64 in OA group required narcotic analgesia [P < 0.001]. Median length of hospital stay [P = 0.672] and postoperative complications [P = 0.779] were comparable in both groups. Median cost of hospital stay was Pakistani Rupees [PKR] 47121/in LA group and PKR 39318/in OA group, the difference being significant [P = 0.001]. Laparoscopic appendectomy is feasible in developing countries with similar postoperative outcome and less requirement of narcotic analgesia. The duration of surgery and overall cost were significantly higher and efforts should be made to develop expertise and reduce operative time with resultant decrease in cost. Development of standardized protocols for discharge of patients from the hospital after LA may further reduce the cost and benefit patients in developing countries

Post-colectomy peristomal pyoderma gangrenosum

We report a patient with peristomal pyoderma gangrenosum which mimicked a necrotizing bacterial infection. It occurred as an extra-intestinal manifestation of chronic mucosal ulcerative colitis [MUC]. Initially misdiagnosed as a cutaneous infection, it finally responded to intravenous high dose corticosteroid therapy