Page 18 - World Journal of Laparoscopic Surgery

MA Bahram

Table 3: operative finding of laparoscopic appendectomy in all patients
No. Percentage
Acute appendicitis 456
Gangernous appendicitis 25
Appendiceal pathology (no. = 504) Perforated appendicitis 2 87.9
Appendiceal abscess 12
Appendicular mass 9
No pathology detected (no. = 38) Normal appendix 38 6.7
Inflamed Mickle’s diverticulum 4
Pathology detected
Inflamed cecal diverticulum 3
Inflamed sigmoid diverticulum 1
omental infarction 4
Nonappendiceal pathology (no. = 31) Ileoceal TB 1 5.4
Chron’s disease 1
Complicated ovarian cyst 16
Perforated gallbladder 1
Total number 31
Conversion to open procedure 11 1.9
operative time range 25­150 minutes
Mean ± SD 42 ± 17.54 minutes

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Table 4: Postoperative complications 2014 who recorded 52 minute for­LA,­Saeed­Kargar­et­al,
11
No. Percentage 2010, who recorded 34.4 minute and Ioannis at, 2008,
range 0.5­10 who recorded 47 minute. The following studies 8,9,11­13
days recorded­that­statistically­there­is­no­significant­difference­
Hospital stay
Mean ± 1 ± 0.21 between­LA­and­OA.­This­was­attributed to the world­
SD days
Post­ Surgical 2 2.8 wide spread of training in laparoscopic techniques that
operative incision lead­to­a­significant­reduction­in­difference­of­operative­
infection time compared to open procedures.
Wound infection
Drain site 9 The infection complications had occurred in 16 patients
extraction 4 (2.8%), most of them were patients with complicated
port site
Intra­abdominal abscess 1 appendicitis (12 from 16 patients: 75%). 14
11
Readmission 1 ­ Kehagias­et­al,­2008 and Tsai et al, 2012, who
Total 16 evaluated­LA­in­all­stages­of­appendiceal­inflammation,­
had recor ded wound infection rate of 5.3% and 4.7 respec­
developed IAA after 3 weeks and readmitted again tively but both of them recorded lower rate of wound
for open drainage of the abscess and the same patient infection­in­LA­in­comparison­to­OA.­Moreover,­Ohtani­
15
developed wound infection. The mean hospital stay in et al 2012, recorded 1.6% rate of wound infection in
this study was 1 ± 0.21 days (Table 4). LA­that­was­significantly lower than OA. This can be
explained­with­the­use­of­the­extraction­bag­in­LA,­which­
dISCuSSIon prevents the direct contact between the infected appendix

Laparoscopic­appendectomy­has­become­the­approach­of­ and the wound during its removal. 13,15
choice by many surgeons in the treatment of both simple Intra­abdominal abscess is a serious complication
and complicated cases of acute appendicitis. The rate of following appendectomy and can potentially be life­
LA­between­1998­and­2008­has­significantly­increased­ threatening; many investigators pay close attention to
from­20.6­to­70.8%.­A­definite­diagnosis­was­obtained­in­ this­complication­and­still­there­is­no­definite­conclusion­
96%­during­LA­compared­with­72%­in­OA. 8 about this complication.
­ Despite­the­obvious­advantages­of­LA­described­in­ Old studies done by some authors reported that the
many studies, 8­10 ­LA­still­remains­a­matter­of­debate­ incidence­of­IAA­was­higher­with­LA. 16­21 It had been

because of concerns about possible longer operative time suggested­that­carbon­dioxide­insufflation­may­promote­
and higher rate of postoperative IAA compared to OA. mechanical spread of bacteria in the peritoneal cavity,
In this study, the mean operative time was 42 ± especially in cases of ruptured appendix, also improper

17.5 minute. throughout the study and it is comparable laparoscopic technique, such as aggressive manipulation
8
to the time recorded in study done by Minutolo et al, of the infected appendix and increased use of irrigation
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