Page 16 - World Journal of Laparoscopic Surgery

WJOLS

MA Bahram 10.5005/jp-journals-10033-1230
OriginaL articLe

Laparoscopic Appendectomy: Is it the Gold Standard

Approach for Management of Acute Appendicitis?

MA Bahram

ABSTRACT InTRoduCTIon
Aim: evaluation of laparoscopic approach for management of Right lower abdominal pain is one of the most common
patients with confirmed or suspected acute appendicitis. causes of patients visit to the emergency department.
Background: Although appendicitis is the most common con-
dition requiring surgery in patients with right lower abdominal Although appendicitis is the most common condition
pain, this pain can be indicative of a vast list of differential requiring surgery in those patients, this pain can be
diagnoses and is thus a challenge for clinicians. A definite diag­ indicative of a vast list of differential diagnoses and is
nosis is obtained in 96% of patients undergoing laparoscopic
appendectomy (LA) compared with 72% of those undergoing thus a challenge for clinicians. Other causes of right
open procedures so patients can avoid the disadvantages of lower quadrant pain aside from appendicitis include
misdiagnosis beside other benefits of LA. infla­mmatory­and­infectious­conditions­involving­the­
Study design: A prospective outcome analysis was done ileocecal region, diverticulitis, malignancies, condi­
for 573 patients over the last 6 years, from 2008 to 2013. All tions affecting the epiploic appendages, omentum, and
patients were planned to go for LA. Modified Alvarado scoring
system was used as a guide in diagnosing all patients. The mesentery. 1
following were recorded: operative time, conversion to open The differential diagnosis of most of those patients is
procedure, intraoperative findings, infection complications and based on clinical ground, laboratory data and diagnostic
length of hospital stay.
imaging. The problem, however, is to obtain a correct
Results: The mean operative time in this study was 42 ± 17.54
minutes. Nonappendiceal pathology was found in 31 patients diagnosis even in sure cases, to determine surgical indi­
(5.4%). Conversion to open procedure was done in 11 patients cations and to decide the best surgical approach. 2
(1.9%). The accurate pathology was detected in 535 (93.3%) During open appendectomy (OA) when the appendix
patients. The infection complications had occurred in 16 patients
(2.6% of all patients). The mean hospital stay in this study was looks apparently normal, the exact diagnosis of abdo­
1 ± 0.21 days. minal pain may not be reached and the management of
Conclusion: Laparoscopic appendectomy is safe and can these patients represents a dilemma for the surgeon and
provide less postoperative morbidity, accurate method in diag­ so­far,­no­guidelines­are­available­in­this­field. Also if the
3
nosing abdominal pathology other than acute appendicitis, and
drawbacks of undiagnosed or misdiagnosed pathology that cause cannot be managed through ordinary McBurney’s
mimic acute appendicitis can be avoided. incision, it is imperative to shift to another incision for
Keywords: appendicitis, Laparoscopy, right lower abdominal management of the surgical problem. 4
pain. McBurney’s procedure represented the gold­standard
5
Abbreviations: OA: open appendectomy; LA: Laparoscopic for acute appendicitis until 1981, when Semm, 1993,
appendectomy; CT: Computed tomography; ECG: electrocardio­ performed­the­first­laparoscopic­appendectomy­(LA)­
graphy; SPSS: Statistical package for the social sciences; DM:
Diabetic mellitus; HCV: Hepatitis C virus; IAA: Intra­abdominal in­ Germany.­ The­ number­ of­ LA­ has­ progressively­
abscess. increased.­But­is­LA­the­best­choice­for­appendectomy?­
How to cite this article: Bahram MA. Laparoscopic Appendec- Are there selected groups of patients in which laparoscopic
tomy: Is it the Gold Standard Approach for Management of Acute approach­should­be­preferred? 6
Appendicitis? World J Lap Surg 2014;7(3):116­120.
The aim of this study is to evaluate the laparoscopic
Source of support: Nil
approach­for­management­of­patients­with­confirmed­or­
Conflict of interest: None suspected acute appendicitis.

PATIenTS And MeThodS
Assistant Professor
This prospective study was conducted over the last
Department of General Surgery, Hepatobiliary and Laparo ­
s copic Surgery, Faculty of Medicine, Menoufia University, Egypt 6 years, from 2008 to 2013. Five hundred and seventy­
Corresponding Author: MA Bahram, Assistant Professor three patients were included in this study. Patients
Department of General Surgery, Hepatobiliary and Laparoscopic presented with acute right lower abdominal pain either
Surgery, Faculty of Medicine, Menoufia University, Egypt, Phone: suspected­or­confirmed­acute­appendicitis­were­included­
00971551095027, e­mail: mahmoudbahreem@yahoo.com
in the study (total 573 patients).
116