Critical Analysis of the Role of Laparoscopy in Appendicectomy : An Institutional Study

Abstract

OBJECTIVE:To evaluate the outcomes of routine open and laparoscopic appendectomy in patients with suspected appendicitis. This is a retrospective study of the outcomes of patients undergoing laparoscopic appendectomy compared with outcomes for patients undergoing open appendectomy during 3year study period. METHODS: It is a retrospective study done in the Department of General Surgery, Chettinad Medical College & Hospital, kelambakkam during the period Jan 2011 -Dec 2013. A total of 100 patients were studied -open (n-50) and laparoscopic procedure (n-50).Results of patients managed with open and laparoscopic procedure for suspected acute appendicitis were reviewed and analyzed. The preoperative and intraoperative findings were recorded. The clinical outcomes were compared in those patients. The various factors like technique of surgery, Duration of surgery, Post-operative morbidity, Analgesic requirement, Antibiotic requirement, Post-operative hospital stay, Complications, Resumption of normal diet, Return to normal activity, Cosmesis were studied. RESULTS: Mean operation time was longer in Lap (45 minutes) as compared to Open (35 minutes).Wound infection regarding skin was seen in 1 patient compared to 3 in open procedure, as the appendix was pulled into the trocar before removing. This maneuver minimizes the chances of wound infection to the skin. 1 Post operative pain and discomfort is less in patients undergoing laparoscopic appendicectomy. Antibiotic and Analgesic requirement was less in Lap group. 2,3 Mean hospital stay was nearly 1/3 rd in Lap group. Better Cosmesis found in Lap group compared to open appendicectomy. Conversion rate was 8% compared to 2 -5 % in literature. 2,3 This is attributed to increase number of complicated cases with adhesions. Post -op complications were seen in 2.5 % of cases compared to 3 -5 % in literature. CONCLUSIONS: We conclude that laparoscopy procedure for suspected acute appendicitis is safe and is associated with a significantly shorter hospital stay. Other intra-abdominal pathologies can also be diagnosed more accurately with the laparoscopic approach.