Page 27 - World Journal of Laparoscopic Surgery
P. 27

WJOLS



              Laparoscopic Appendectomy as a Standard of Care for Both Complicated and Uncomplicated Appendicitis in South Africa
             The main cause of morbidity was ventilator-associated  REFERENCES
          pneumonia and deep vein thrombosis (DVT). These       1.  Ekah AP, Wozniak CJ, Monson B, Crawford J, McCarthy MC.
          were patients who were admitted to intensive care unit   Laparoscopic in the contemporary management of acute
          (ICU). Also, improvement in ICU care and appropriate    appendicitis. Am J Surg 2007 Mar;193(3):310-314.
          use of venous thromboembolism are measures we should     2.  Garbutt JM, Soper NJ, Shannon WD, Botero A, Littenberg B.
          improve on.                                             Meta analysis of randomized controlled trials comparing
             Mortality was 1.7%, which is higher than reported    laparoscopic and conventional appendectomy. Surg Laparosc
                                                                  Endosc 1999 Jan;9(1):17-26.
                              18
          by other researchers.  Majority of the causes were     3.  Chung RS, Rowland DY, Li P, Diaz J. A meta analysis of ran-
          nonprocedure-related causes. Systemic sepsis and acute   domized controlled trials of laparoscopic versus conventional
          respiratory distress syndrome (ARDS) contributed to a   appendectomy. Am J Surg 1999 Mar;177(3):250-256.
          significant proportion to mortality. Both of the causes     4.  Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appen-
                                                                  dectomy: a meta analysis. J Am Coll Surg 1998 May;186(5):
          were found in the four-quadrant pus subgroup. Majority   545-553.
          of these patients were delayed presentation and often     5.  Slim K, Pezet D, Chipponi J. Laparoscopic or open appen-
          came in septic shock and needed postoperative care      dectomy? Critical review of randomized controlled trials.
          in ICU. Many of them were ventilated for more than      Dis Colon Rectum 1998 Mar;41(3):398-403.
          a week. Therefore, delayed presentation, septic shock,     6.  Long KH, Bannon MP, Zietlow SP, Helgeson ER, Harmsen WS,
                                                                  Smith CD, Ilstrup DM, Baerga-Varela Y, Sarr MG, Laparo-
          and prolong ICU stay seem to be a major contributing    scopic Appendectomy Interest Group. A prospective random-
          factors to mortality.                                   ized comparison of laparoscopic appendectomy with open
             The results of this study seem to be comparable to   appendectomy: clinical and economic analyses. Surgery 2001
          previous studies and the negative outcome seen in the   Apr;129(4):390-400.
          four-quadrant pus subgroup seem to be due to patients’     7.  Fingerhut A, Millat B, Borrie F. Laparoscopic versus open
                                                                  appendectomy: time to decide. World J Surg 1999 Aug;23(8):
          factors and not procedure-related.                      835-845.
                                                                8.  Maxwell JG, Robinson CL, Maxwell TG, Maxwell BG, Smith CR,
          CONCLUSION                                              Brinker CC. Deriving the indications for laparoscopic appen-
                                                                  dectomy from a comparison of the outcomes of laparoscopic
          The positive outcome found in this study when LA was    and open appendectomy. Am J Surg 2001 Dec;182(6):687-692.
          used in both complicated and uncomplicated cases of     9.  Peiser JG, Greenberg D. Laparoscopic versus open appen-
          acute appendicitis suggests that this approach is possible   dectomy: results of a retrospective comparison in an Israeli
          in carefully selected patients and with appropriate basic   hospital. Isr Med Assoc J 2002 Feb;4:91-94.
          laparoscopic skills.                                  10.  Garg CP, Vaidya BB, Chengalath MM. Efficacy of laparoscopy
                                                                  in complicated appendicitis. Int J Surg 2009 Jun;7(3):250-252.
             However, we recognize the limitations of our study:     11.  Frazee RC, Bohannon WT. Laparoscopic appendectomy for
          Retrospective study, with a small study population size.   complicated appendicitis. Arch Surg 1996 May;131(5):509-512.
          Therefore, more studies with large population size are     12.  Pai PS, Towson JA, Anthone GJ, Ortega AE, Simons AJ,
          needed to establish the role of LA as the standard of care   Beart RW Jr. Intra abdominal abscesses following laparo-
          in both complicated and uncomplicated cases of appen-   scopic and open appendectomies. J Gastrointest Surg 1997
                                                                  Mar-Apr;1(2):188-192.
          dicitis (Appendix 1). 19                              13.  Ball CG, Kortbeck JB, Kirkpatrick AW, Mitchell P. Laparoscopic
                                                                  appendectomy for complicated appendicitis: an evaluation of
                                                                  postoperative factors. Surg Endosc 2004 Jun;18(6):969-973.
                        Appendix 1: Alvarado score              14.  Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic appen-
                                                                  dectomy conversion rates two decades later: an analysis of
           Variables  Clinical features    Score                  surgeon and patient-specific factors resulting in open conver-
           Symptoms  Migratory RIF pain    1                      sion. J Surg Res 2012 Jul;176(1):42-49.
                     Anorexia              1                    15.  Bombil I, Lunda WS, Maraj A. Laparoscopic appendectomy
                                                                  for complicated appendicitis at Sebokeng Hospital. J Dent
                     Nausea and vomiting   1                      Med Sci 2015 Dec;14(12):65-69.
           Signs     Tenderness (RIF)      2                    16.  Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R.
                     Rebound tenderness    1                      Laparoscopic versus open appendectomy a prospective ran-
                                                                  domized double-blind study. Ann Surg 2005 Sep;242(3):439-450.
                     Elevated temperature  1                    17.  Tate JJ. Laparoscopic appendectomy. Br J Surg 1996 Sep;83
           Laboratory  Leukocytosis        2                      (9):1169-1170.
                     Shift to left (neutrophils)  1             18.  Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED,
           Total score                     10                     Eubanks S, Pietrobon R. Laparoscopic versus open appendec-
                                                                  tomy outcomes comparison based on a large administrative
           Score     Significance          Plan                   database. Ann Surg 2004 Jan;239(1):43-52.
           ≤ 3       Appendicitis unlikely  Observation         19.  Mckay R, Shepherd J. The use of the clinical scoring system
           4–6       Appendicitis likely   Imaging (U/S or CT)    by Alvarado in the decision to perform computed tomogra-
           7–10      Appendicitis highly likely                   phy for acute appendicitis in the ED. Am J Emerg Med 2007
                                                                  Jun;25(5):489-493.
          World Journal of Laparoscopic Surgery, January-April 2017;10(1):22-25                             25
   22   23   24   25   26   27   28   29   30   31   32