Is it worthy to perform appendectomy laparoscopically: clinical outcome and interleukin response

ABSTRACT

Laparoscopic appendicectomy [LA] was found to be as .safe as open appendicectomy [OA]. However, LA was also found to have higher cost than OA, Surgical injury and sepsis are known factors which stimulate the production and the release of a variety of cytokines that reflect the degree of stress, The aim of the present study was to find out if LA is less invasive than OA in terms of clinical outcome and interleukin response. Thirty patients clinically diagnosed as acute appendicitis were prospectively studied. Eight cases proved to have another pathology were excluded from the immunological study The two groups with proved acute appendicitis are Group I [12 patients] operated upon by open approach and group II[10 patients] operated upon laparoscopically Assays for IL-1beta, IL-4 and IL-15 were performed by highly .sensitive in-house protocols assorted developed and standardized in our lab. The results showed an increase in IL-1 beta from preoperative level to a higher 2 hours level, thereafter the value declined. The values are higher in open surgery than in laparoscopic operations' although the difference did not reach statistical significance. IL-4 showed a decrease in open surgery and rather stable results in laparoscopic operations. IL-15 showed a blunted decrease to the lowest detectable level of the assay of 2pg/ml. Patients in groups II had shorter hospital stay, earlier return to activities and less wound infection. Laparoscopy allowed easier exploration and dealing with detected pathology. Based on the results of the present study, the laparoscopic technique is less stressfull. However it remains more expensive and needs more expertise. Moreover, it offers an extra value in doubtful diagnosis as it allows better abdominal exploration