This was a prospective randomized controlled study designed to compare laparoscopic and open interval appendectomy and involved 100 patients of appendicular phlegmon. After initial conservative management, patients were divided into 2 groups of 50 each and interval appendectomy was performed by laparoscopy in one of the groups and by open method in the other. Mean operative time in open surgery was 33.9 minutes and that in laparoscopic surgery was 57.64 minutes (P < 0.05). Concomitant pathology was observed in 16% and 2% of patients in the laparoscopic and open groups, respectively. Mean pain scores on the first postoperative day were 5.14 in the laparoscopic group and 6.01 in the open group (P < 0.05). Patients in the laparoscopic group had a shorter duration of ileus, postoperative stay, and returned to work earlier (P < 0.05). We conclude that laparoscopy offers a number of advantages over open interval appendectomy.

Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47%) patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot's triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries.

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