Page 4 - World Journal of Laparoscopic Surgery

Laparoscopic Appendicectomy and Complicated Appendicitis
Table 1: Inclusion and exclusion criteria for patient selection for the study supine position. All patients underwent laparoscopic and open
Inclusion criteria Exclusion criteria appendectomy depending upon the surgeon’s preferences. A
Age 13 years and over Age under 13-years standard laparoscopic approach was employed for laparoscopic
appendectomy using 3-port LC techniques with surgeons on the
Patient with confirmed The patient presented with an left side of the patient. The patient was catheterized preoperatively.
complicated appendicitis appendicular mass A midline infraumbilical skin incision was made followed by the
intraoperative or histologically insertion of a 10-mm trocar for the camera-port. Carbon dioxide
Patient with laparoscopic The patient who had developed gas was insufflated at a pressure of 10–12 mm Hg. Another 5-mm
converted to open complications like abscess trocar was inserted under camera vision, at the suprapubic area
appendectomy collection, reoperation, etc. after
30 days postoperatively on the midline. At the last port, a 5-mm trocar was inserted on a
left side abdomen under direct vision. For open appendectomy,
Lanz incision was performed on almost all the patients; all
Flowchart 1: Patients recruitment appendectomies involved a muscle-splitting right lower quadrant
incision. The appendix and any adherent omentum were removed.
Irrigation was performed for both LA and OA.
Postoperatively, most of the patients were prescribed oral
analgesics and allowed orally gradually. Intravenous antibiotics
were continued for a few days postoperatively and the patients
were subsequently discharged with oral antibiotics to complete
one week course.

Definition of Terms
Perforated appendicitis: Intraoperative evidence of perforation or
intra-abdominal fecalith.
Complicated appendicitis: Gangrenous, macerated, or grossly
inflamed with pus collection or suppurative appendicitis and
MAterIAls And Methods including perforated appendicitis.
Background and Study Design Surgical site infection (SSI): Operative wound site that showed
The medical records of the patients who underwent LA from purulent discharge associated with surrounding cellulitis with
January 2014 to December 2015 were reviewed. Two clinical centers: other inflammatory signs and that needed to be opened. It can be
Hospital Selayang in Selangor, and Hospital University Kebangsaan superficial incisional, deep incisional, and organ or space infection.
Malaysia (HUKM) in Kuala Lumpur were chosen for this study. These Superficial incisional SSI is infection up to subcutaneous tissue; deep
two hospitals are the tertiary hospitals that offer wide spectra of incisional SSI is infection up to fascia and muscle; organ and space
medical services including minimally invasive surgery (MIS) facilities. infection SSI is an abdominal infection.
LA and OA were performed by different specialists or trainees
in both hospitals. The patients were selected depending on the Abscess collection: The intra-abdominal collection is confirmed
inclusion and exclusion criteria (Table 1). by radiological imaging and needs to be drained by surgery,
Patients with earlier laparoscopic appendectomy and percutaneous drainage, or continuation of antibiotics.
converted to open appendectomy were included in the study and Enterocutaneous fistula: Communications between bowel and skin
grouped into the laparoscopic group (Flowchart 1). causing discharging of bowel contents.
Data on preoperative, intraoperative, and postoperative
parameters were collected and properly maintained. The variable Reoperation: Reoperation is a second surgical procedure performed
analyses included demographics data, comorbid factors, operative in the same site for the same indications.
procedures and duration, and postoperative complications and Specialist: A person who has completed a Master’s in surgery or any
outcomes, such as surgical site infection, reoperation, length other specific fellowship training program.
of hospital stay, and patient satisfaction level. The 30-day
postoperative morbidity data collected were: surgical site infection, Trainee: A person who performs the duty of a medical officer and/
reoperation, length of hospital stay, and enterocutaneous fistula or is in the Master of the surgery training program.
rate.
results
Operative Method A total of 712 patients with acute appendicitis were admitted to and
A clinical diagnosis of perforated appendicitis was done by the operated upon during the study period of two years from January
on-call surgeon based on the signs and symptoms, i.e., right 2014 to December 2015 at Hospital Selayang and Hospital Universiti
lower abdominal pain, particularly in the right iliac fossa, fever, Kebangsaan Malaysia (HUKM). A majority (58.4%) of the cases
and other associated symptoms. Antibiotics were started while involved open appendectomy. The mean age of the patients for OA
waiting for the operation. The operation was done immediately and LA were 30 (±14) and 32 (±15) years, respectively. The majority of
after the operation theatre was available. Surgery was performed cases were male in both procedures; 72.8% for open appendectomy
under general anesthesia and the patient was placed in a and 52.4% for laparoscopic appendectomy (Table 2). Most of the

2 World Journal of Laparoscopic Surgery, Volume 14 Issue 1 (January–April 2021)