Page 24 - World Journal of Laparoscopic Surgery

WJOLS

Fusi Mosai, Zach M Koto 10.5005/jp-journals-10033-1296
OriginaL articLe

Laparoscopic Appendectomy as a Standard of Care for

Both Complicated and Uncomplicated Appendicitis in
South Africa, Is It Safe? Single Center Experience

2
1 Fusi Mosai, Zach M Koto

ABSTRACT Source of support: Nil
Aim: The aim of this descriptive analytical study was to describe Conflict of interest: None
the outcomes of using laparoscopic appendectomy (LA) as the
standard of care for both complicated and uncomplicated cases
of acute appendicitis in South Africa. INTRODUCTION
Background: Laparoscopic appendectomy has been widely Laparoscopic appendectomy (LA), initially described by
accepted as safe when performed in uncomplicated cases of Semm in 1983, has increasingly gained favor in the past
acute appendicitis. However, acceptance of this procedure as the decade in management of selected cases of acute appen-
standard of care has been surrounded by controversies, with the 1
main concern been around the safety of this procedure in com- dicitis. The benefits of LA as a minimal access surgery
plicated cases of appendicitis. Currently, there is no consensus include less postoperative pain, shorter hospital stay,
2-4
in published literature regarding the use of LA as the standard early return to work, and better cosmesis. These bene-
of care in both complicated and uncomplicated appendicitis. fits have made this approach attractive. However, despite
Materials and methods: A retrospective analysis of all patients all these benefits, LA has not been wildly accepted as a
who were diagnosed with acute appendicitis at Dr George standard of care for management of all cases. This is
5
Mukhari Academic Hospital over a 3-year period was reviewed.
Data were retrieved from our departmental database and ana- due to dispute regarding its advantage compared with
lyzed using descriptive statistics. open surgery. 1,6-9
The controversies around high procedure-related
Results: A total of 746 patients were reviewed and 576 were
included in the study. All these patients were offered LA. The complication rate and conversion rate associated with
mean age was 26.37, with 66% of our patients been males. LA when used in complicated cases of appendicitis have
Complicated cases formed 38% of our total study population. led to some authors questioning the safety of this pro-
Laparoscopic appendectomy was performed in both compli- 10-12
cated and uncomplicated cases of appendicitis with a success cedure, especially in complicated cases. Most acute
rate of 96%. Intraoperative complication rate and the relook rate appendicitis cases present after hours are often managed
was 0.5 and 7% respectively, with an overall mortality of 1.7%. by residents. This has also been quoted in the literature
Conclusion: The positive outcome found in this study when as a potentially contributing factor to high complication
13
LA was used in both complicated and uncomplicated cases of rate due to lack of skill. Currently, there is no general
acute appendicitis suggests that this approach is possible in consensus regarding the safety and feasibility of using
carefully selected patients and with appropriate basic laparo-
scopic skills. LA in complicated cases of appendicitis.
Contrary to what has been practiced and reported in
Clinical significance: Complicated appendicitis is not a con- the literature, LA was introduced as the standard of care
traindication to laparoscopy.
at Dr George Mukhari Academic Hospital (DGMAH) for
Keywords: Appendicitis, Complicated appendicitis, Laparo- both complicated and uncomplicated cases of appendici-
scopic appendectomy, Uncomplicated appendicitis.
tis in 2011. Most of the cases at this facility present after
How to cite this article: Mosai F, Koto ZM. Laparoscopic hours and are managed by residents on site. The DGMAH
Appendectomy as a Standard of Care for Both Complicated
and Uncomplicated Appendicitis in South Africa, Is It Safe? is a tertiary teaching hospital with a bed capacity of 1,500,
Single Center Experience. World J Lap Surg 2017;10(1):22-25. situated in Gauteng province. The hospital takes referrals
from at least three provinces namely Gauteng, Northwest,
and Limpopo provinces.
1 Junior Consultant, Head, Professor and Chairman A departmental database was used to store all the
2
1,2 Department of General Surgery, Sefako Makgatho Health information of patients managed with LA and it is
Sciences University, Pretoria, Gauteng, South Africa updated and checked for accuracy during our weekly
Corresponding Author: Fusi Mosai, Junior Consultant morbidity and mortality meetings.
Department of General Surgery, Sefako Makgatho Health All patients who presented with a preoperative assess-
Sciences University, Pretoria, Gauteng, South Africa ment of acute appendicitis, in all age groups were offered
Phone: +0125214150, e-mail: fusimosai@yahoo.co.uk
LA, hence, were considered for the study.
22