Page 23 - World Journal of Laparoscopic Surgery

Laparoscopic versus Open Appendectomy for the Treatment of Acute Appendicitis

the laparoscopic group. Minor complications were 20% in open recovery. A group of 106 patients with a body mass index (BMI)
and 13% in laparoscopic appendectomy. 76 > 26.4, representing the upper quintile of 500 prospectively

Paya et alpublished a prospective study of 75 children with randomized patients, were included in the study. They were
perforated appendicitis. Ten underwent laparoscopic randomized to undergo either laparoscopic or open
appendectomy and the remainder underwent open operation. appendectomy. Following parameters were evaluated:
There were no postoperative abscesses in the laparoscopic • Operating and anesthesia times
group but 2 (3.1%) of 65 patients who had open appendectomies • Postoperative pain
developed postoperative intra-abdominal abscesses. 38 • Complications
In a prospective series of children aged 4-12 years, reported • Hospital stay
from Cairo, 48 underwent open appendectomy and 34 • Functional index (1 week postoperatively)
laparoscopic operation, over a 6 month period. Wound • Sick leave, and
complications were fewer, cosmetic appearance better, and time • Time to full recovery.
to return to normal activities quicker (7 cf 12 days) in the The prolonged hospital stay and sick leave noted in
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laparoscopic group. Lintula H, et al studied the effect of overweight patients undergoing open appendectomy was
laparoscopic appendectomy in children between 4-15 yr of age abolished when overweight patients were treated with
and demonstrated that laparoscopic appendectomy was not laparoscopic appendectomy. Laparoscopic procedures are
associated with any increase risk of intraoperative or long-term however more prolonged in the obese than in the normally
complications. 32 nourished. 13,57 There is opinion of some surgeons that
laparoscopy is beneficial in obese females and those presenting
Appendectomy in Pregnancy with appendiceal abscess, who are treated by intravenous
antibiotics and percutaneous drainage followed by interval
Is laparoscopic appendectomy safe in pregnancy? There has appendectomy. But in their opinion laparoscopic appendectomy
been increased interest in using laparoscopic procedures during is not indicated in all patients presenting with periappendicular
pregnancy. A prospective study was done to evaluate the safety abscess. 57
and outcome of pregnancy after both open and laparoscopic
procedures. 11 pregnant women underwent laparoscopic
appendectomy and 11 underwent open appendectomy. Their Postoperative Pain
gestation age ranged from 7 to 34 weeks. The following It is proved that laparoscopic procedures cause less post-
parameters were analyzed: operative pain than their conventional counterparts. In this
• Obstetric and gynecologic risk factors study none of the literature reviewed found more pain after
• Length of procedure laparoscopic procedure. The postoperative narcotic use is less
• Perioperative complications after laparoscopic appendectomy. In one study done by Ortega
• Length of stay and outcome of pregnancy. et al; linear analogue pain scores were recorded in 135 patients
The study showed that laparoscopic appendectomy is safe
in all trimesters of pregnancy. There was no significant difference blinded to the procedure of operation by special dressing and
pain score was very less in laparoscopic group compared to
in the length of operation. (60 vs 46 min). There was no fetal open. Another interesting observation has been the patient’s
loss or other adverse outcome of pregnancy after laparoscopic perception of pain after appendectomy. Those who underwent
appendectomy. The development of the infant was normal in laparoscopic appendectomy were more vocal of pain although
both the group of patients. 33 it was of a lower intensity. However, after 48 hours they had a
While these reports indicate that laparoscopy can be safely
performed during pregnancy, some surgeons are suggesting better sense of well-being and showed earlier postoperative
food intake, ambulation and return to work and sport. This
that whenever possible, operative intervention should be could have arisen from the expectation that laparoscopic
deferred until the second trimester when fetal risk is lowest. 68 procedures are painless or a lower level of endorphins released
Pneumoperitoneum enhances lower-extremity venous stasis, or the peritoneal injury from the pneumoperitoneum.
which already present in gravid patient. Pregnancy also induces
a hypercoagulable state, so pneumatic compression devices
must be utilized in pregnant women at the time of appendectomy Postoperative Recovery after Appendectomy
to prevent thromboembolism.
It has been shown that those patients who underwent successful
laparoscopic appendectomy have a better postoperative
Appendectomy of Obese Patients
recovery. The reduced trauma to the abdominal wall is a very
In the obese patient laparoscopic appendectomy has shown significant factor in postsurgical discomfort. The better mobility
advantage over the open procedure in a faster postoperative of the abdominal musculature and the earlier ambulation, reduce

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