Page 27 - World Journal of Laparoscopic Surgery

Laparoscopic versus Open Appendectomy for the Treatment of Acute Appendicitis

Visceral Injury Intra-abdominal Abscess

Risk of accidental burns is higher with monopolar system This postoperative morbidity is recognized by prolonged ileus,
because electricity seeks the path of least resistance, which sluggish recovery, rising leukocytosis, spiking fevers,
may be adjacent bowel. In a bipolar system since the current tachycardia, and rarely a palpable mass. After confirmation of
does not have to travel through the patient, there is little chance the intra-abdominal abscess drainage of pus followed by
of injury to remote viscera. In laparoscopic appendectomy only antibiotic therapy is essential. Sometime laparotomy may be
bipolar current should be used. Laparoscopists should also required.
routinely explore the rest of the abdomen.
Hernia

Wound Infection Trocar site hernia as visible or palpable bulge is sometime
encountered. Possible occult hernia manifested by pain or
It is recognized by erythema, fluctuation and purulent drainage symptoms of bowel obstruction.
from port sites. The absence of wound infections after Laparoscopic appendectomy is now safe in experienced
laparoscopic appendectomy can be attributed to the practice of hands. In experienced hands, satisfactory peritoneal toilet can
placing the appendix in a sterile bag or into the trocar sleeve be performed even in the presence of Peri-appendiceal pus and
prior to removal from the abdomen. The regular use of retrieval regional peritonitis. Laparoscopic appendectomy is not
bag is a very good practice for preventing infection of the advocated when the patient has generalized peritonitis.
wound.
Indications for the surgical treatment of appendicitis:

Laparoscopic appendectomy Open appendectomy
Incomplete Appendectomy
If surgeon is not experienced, the stump of the appendix may be Female of reproductive age group Complicated appendicitis
to long. There is a report of intra-abdominal abscess formation Female of premenopausal group COPD or cardiac disease
due to retained faecolith after laparoscopic appendectomy. It is Suspected appendicitis Generalized peritonitis
strongly advised that the surgeons performing laparoscopic
appendectomy should remove faecolith if found, and the stump High working class Previous lower abdominal surgery
of appendix should not big enough to contain any thing. 11 Obese patients Hypercoagulable sates
Incomplete appendectomy is a result of ligation of the appendix Disease conditions like Stump appendicitis after previous
too far from the base. It may lead to recurrent appendicitis, cirrhosis of liver and sickle Incomplete appendectomy
which presents with symptoms and signs of appendicitis even cell disease
after laparoscopic appendectomy. Immune-compromised patients
Some surgeons prefer stapling of the appendiceal stump
for laparoscopic appendectomy for the treatment of all forms of Future Prospects of Laparoscopic Appendectomy
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appendicitis. But most of the surgeons now agree that ligation
of the appendectomy stump is the best approach. There is report In the future, remote handling technology will overcome some
of slippage of clip, residual appendicitis followed by abscess of the manipulative restriction of current instruments. There is
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formation after using clip for appendiceal stump. The ligation no doubt that 20 years from now some surgeons will be
should be preformed by using endoloop, an intra-corporeal operating exclusively via a computer interface controlling a
surgeon’s knot, or done extra corporeally using a Meltzer’s master–slave manipulator. But the future of any new technology
knot or Tayside knot. The security of the knot is essential. It is depends upon applications and training. 3
influenced by the proper port location and experience of the
surgeon. 4 CONCLUSION

Laparoscopic appendectomy is equally safe, and can provide
Leakage of Purulent Exudates from less postoperative morbidity in experienced hands, as open
Appendix at the time of Operation
appendectomy. Most cases of acute appendicitis can be treated
Usually seen intraoperatively while dissecting appendix. laparoscopically. Laparoscopic appendectomy is a useful
Copious irrigation and suction followed by continued antibiotics method for reducing hospital stay, complications and return to
can prevent this complication until patient is afebrile with a normal activity. With better training in minimal access surgery
normal white blood cell count. Use a retrieval bag. to prevent now available, the time has arrived for it to take its place in the
the spillage of infected material from the appendiceal lumen. surgeon’s repertoire.

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