Page 19 - World Journal of Laparoscopic Surgery

WJOLS

Laparoscopic Appendectomy: Is it the Gold Standard Approach for Management of Acute Appendicitis?
fluid,­possibly­producing­greater­contamination­of­the­ especially if the conversion was due to improper surgical
peritoneal cavity, might have an impact on IAA formation laparoscopic technique.
after­LA. 19 The conversion rate in this study was in 11 (1.9%) of
However, recent meta­analysis of randomized con­ patients and the main cause of conversion was due to non
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trolled trail published by Wei et al, 2011, shows a low appendiceal pathology detected (9 from 11) and the other
incidence of intra­abdominal infections, with no signi­ two­patients­were­due­to­appendiceal­inflammation.­This­
ficant­difference­between­LA­and­OA.­A­multivariate­ rate of conversion is nearly equal to the result recorded by
8
analysis has shown that development of abscesses has a Minutolo et al, 2014, who recorded a rate of conversion
higher correlation with the initial diagnosis rather than 1.4% (2 from 139 patients).
with the type of surgical approach. 6,14 Higher conversion rate may be due to gaining experi­
Intra­abdominal abscess had occurred in one patient ences with the laparoscopic procedure so surgeons might
(0.02) in this study. This is comparable to the result attempt­to­perform­LA­for­complicated­cases­of­appendi­
14
recorded by Ching et al, 2012 who did not record cases citis, most of which might have been treated previously
with IAA and Brümmer et al, 2009, who recorded rate by open approach. 13
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of­IAA­with­LA­0.31%­of­their­patients.­Katkhouda­et­al­ ­ Another­advantage­of­LA­is­shorter­hospital­stay,­
8
(2000) and Vincenzo Minutolo et al, 2014, believed that in this study; the mean hospital stay was 1 ± 0.21 days.
23
mastery of the learning curve and the use of standar dized This differs from the results recorded by Minutolo et al,
8
surgical techniques reduced­the­incidence­of­IAA­after­LA.­ 2014 ­who­recorded­mean­hospital­stay­in­LA­2.75­days­
­ Laparoscopy­can­be­considered­the­first­choice­in­ and­also­Ioannis­et­al,­2008,­recorded­hospital­stay­for­LA­
suspected appendicitis allowing correct evaluation of 2.2 days but both of them stated that there was a signi­
intra­peritoneal pathology. 6,15,24,25 ficant­difference­between­both­LA­and­OP­regarding­
The correct pathology was detected in 535 or 93.3% of hospital stay.
the patients, while another pathology rather than acute
appendicitis was detected in 31 or 5.4% of the patients. ConCLuSIon
From­those­31­patients,­27­patients­gained­extra­benefit Laparoscopic­appendectomy­is­safe­with­accepted­post­
from laparoscopic approach: eight patients avoided operative morbidity. Most cases of acute appendicitis can
undiagnosed pathology, 15 patients avoided wound be­treated­laparoscopically.­LA­is­an­accurate­method­
extensions and excess tissue manipulation for pathology in diagnosing abdominal pathology other than acute
management and four patients avoided adding another appendicitis, avoiding patients the drawbacks of undiag­
surgical incision to McBurney incision (Table 5). nosed or misdiagnosed pathology that mimic acute
The results in this study concedes with the results appendicitis. With better training in laparoscopic surgery
26
in the study conducted by Ma et al, from 271 patients and­availability­of­equipment:­LA­will­be­sooner­the­gold­
with a normal appendix, extra­appendiceal pathology standard for acute appendicitis.
was found in 71 (4.8% of all appendectomies).
­ Conversion­from­LA­to­OA­is­one­of­the­drawbacks­ RefeRenCeS
of laparoscopic approach as it prolongs the operative
time, hospital stay and may even increase the morbidity 1. Purysko AS,­Remer­EM,­LeãoFilho­HM,­Bittencourt­LK,­
Limaand­RV,­Racy­DJ.­Beyond­appendicitis:­common­and­
uncommon gastrointestinal causes of right lower quadrant
Table 5: benefits of laparoscopic approach in detecting
nonappendiceal pathology abdominal pain at multi­detector CT1. Radio Graphics 2011;
31:927­947.
Patients avoided Sigmoid diverticulitis 1 ­ 2.­ Casciola­L,­Ceccarelli­G,­Bartoli­A,­D’Ajello­F,­Bellochi­R,­
misdiagnosis Valeri­R,­Rambotti­M,­Spaziani­A,­Mazzoli­W,­DiZitti­L.­
omental infarction 3 Laparoscopic­approach­versus­laparotomy­for­suspected­
Left ovarian cyst 4 acute appendicitis. G Chir 2002;23:440­444.
Patients avoided Ovarian cyst 12 ­ 3.­ Jaunoo­SS,­Hale­AL,­Masters­JPM,­Jaunoo­SR.­An­international­
extension of survey of opinion regarding investigation of possible appen­
McBurney incision 4.7% dicitis and laparoscopic management of a macroscopically
Ileo­cecal disease 3 normal appendix. Ann R Coll Surg Engl 2012;94:476­480.
Patients avoided shift Perforated GB 1 4. Navez B, Therasse A. Should every patient undergoing
to another incision laparoscopy for clinical diagnosis of appendicitis have an
Ileo­ceal TB 1 appendicectomy?­Acta­Chir­Belg­2003;103:87-89.
Cecal diverticulum 2 ­ 5.­ Semm­K.­Endoscopic­appendectomy.­Endoscopy­1983;15:
Total 27 59­64.

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