Background: Laparoscopic appendectomy has been widely practiced for uncomplicated appendicitis. Various reports demonstrated its merits in reducing postoperative pain, analgesic requirement, incidence of wound infection, and hospital stay. The role of laparoscopy in management of complicated appendicitis remains undefined. Complicated appendicitis is associated with a significant risk of postoperative morbidity, making the value of the minimally invasive approach is superior. Methods: This is a retrospective study done in Chittagong Medical College Hospital and various private hospitals in Chittagong from January 2008 to June 2011. Sixty patients with complicated appendicitis included perforated appendicitis, gangrenous appendicitis, and appendicular abscess or lump found intra-operatively. The conversion rate, operative time, postoperative abdominal and wound infections, the return to oral intake, and the length of hospitalization were analysed. Laparoscopic appendectomy was done by three trocar techniques in all cases. Results: During the study period, 60 patients underwent laparoscopic appendectomy for complicated appendicitis. There were 35 patients with perforated appendicitis, 12 patients with gangrenous appendicitis, and 13 patients with early appendicular lump or abscess. The average operating time was 65 min. The average length of hospitalization was 3.2 (2-5) days. The postoperative narcotic analgesic requirement was minimal. Laparoscopy was converted to open surgery in two patients (3.33%). Four (6.6%) had postoperative complications (diarrhoea). Three patients developed (5%) wound (port) infection. There was no statistically significant difference in operative time (P 0.13). There was no mortality in the current series. Conclusions: Laparoscopic appendectomy is a safe and feasible treatment option in complicated appendicitis. It is advantageous than open surgery because of less wound infection, less morbidity, less hospital stay, early return to work, and not associated with increased risk of septic postoperative complications.

Appendicectomy is one of the most common surgical procedures in day to day practice in Bangladesh. Although it is considered a safe operation, a potential complication developed in complicated appendicitis. Surgical site infection is one of those noticeable complications. Infection of wound still remains one of the main postoperative morbidities and as a result, prolonged hospitalization in those undergoing open appendicectomy(OA).Laparoscopic appendectomy (LA) has been widely practiced for uncomplicated appendicitis. The role of laparoscopy in management of complicated appendicitis remains undefined. Complicated appendicitis is associated with a significant risk of postoperative morbidity, making the value of the minimally invasive approach is superior. This is a retrospective study comparing SSI in laparoscopic appendicectomy versus open appendicectomy. The study was performed on 120 patients which were clinically and after investigation diagnosed as a case of complicated appendicitis from January 2008 to June 2011. Out of them 60 patient were done by laparoscopically and 60 patients by open method. Complicated appendicitis includes perforated appendicitis, gangrenous appendicitis and appendicular abscess or early lump found intra-operatively. Patients were excluded if the diagnosis of appendicitis was not clinically established and if they had a history of symptoms for more than 5 days and/or a palpable mass in the right lower quadrant. The conversion rate, operative time, SSI (postoperative abdominal and wound infections), the return to oral intake, and the length of hospitalization were analyzed .The aim of this study is to compare the SSI between LA and OA for complicated appendicitis. In 60 patients of laparoscopic appendectomy for complicated appendicitis there were 35 patients with perforated appendicitis, 12 patients with gangrenous appendicitis and 13 patients with early appendicular lump or abscess. There were 42 males and 18 females, mean age 24 yrs (range, 18 to 32), The average operating time was 65 minutes. The average length of hospitalization was 3.2(2-5) days. The post operative narcotic analgesic requirement was minimal. Laparoscopy was converted to open surgery in two patients (3.33%). Four (6.6%) had post operative complications (diarrhea). Nine patients developed (15.00%) developed wound (port) infection. SSI . No statistically significant differences in operative time (P0.13) There was no mortality in the current series. Laparoscopic appendectomy is a safe and feasible treatment option in complicated appendicitis. It is advantageous than open surgery because of less wound infection, less morbidity, less hospital stay and early return to work and not associated with increased risk of septic postoperative complications. JCMCTA 2013; 24 (1):53-57

Background: Due to the fear of postoperative pain and complications associated with open Milligan-Morgan (MM) surgery, mildly symptomatic patients often hesitate and delay undergoing surgical treatment for internal haemorrhoids. Laser Hemorrhoidoplasty (LHP) has been gaining popularity recently in the management of hemorrhoid. This study aimed to evaluate the efficacy of the LHP compared with MM surgery in the management of internal haemorrhoids. Materials and methods: This multi-center, open label, randomized controlled trial included 60 patietns with secondand third-degree internal haemorrhoids. The patients were randomized in a 1:1 ratio to receive either LHP (Group I) or conventional MM hemorrhoidectomy (Group II). Primary outcome parameter was postoperative pain assessed by Visual Anlougue Scale (VAS) at 24 hours, 7 days and 30 postoperative days. Results: Both the groups were comparable in terms of the demographic characteristics. The mean operation time was significantly lower in group I than group II (19.13±3.42 vs. 28.67±4.54 minutes, p<0.001). The mean VAS score of pain at 24 hours and 7 days postoperative were significantly lower in group I than in group II (p<0.001 and p<0.004, respectively). At postoperative, 30 days the mean VAS scores were similar in both groups (p=0.722). The mean total days of consumed analgesic were significantly shorter in group I than in group II (7.94±5.79 vs. 11.01±2.96 days, p<0.001). The mean time to return to regular activity was significantly earlier in group I than in group II (8.76±3.58 vs. 13.6±3.47, p<0.001). Postoperative bleeding was less in group I than in group II (6.6% vs. 26.7%). The mean length of hospital stay, rate of complete resolution and need for medical treatment for residual symptom and repeated surgery were similar between two groups. Conclusion: LHP was associated with reduction of postoperative pain, postoperative bleeding, and administered with analgesics. So, if available LHP is preferred to open hemorrhoidectomy. IAHS Medical Journal Vol 5(2), Dec 2022; 15-19