Page 6 - World Journal of Laparoscopic Surgery

Laparoscopic Appendicectomy and Complicated Appendicitis

dIscussIon of the study is the lack of defined selection criteria for an operative
Acute appendicitis course of the disease may later progress to approach for each patient. The decision for the operative approach
is based on the surgeon’s preferences. Hence, selection bias for the
complicated appendicitis if not treated at an earlier stage. The decision for surgical approach in this study could not be excluded.
late presentation may lead to disastrous morbidity and mortality.
In our study, appendicitis was more common in young male
adults, as the mean age group for LA vs OA was 32 (±15) and 30 conclusIon
(±14) years, respectively. A study done by Yau et al. demonstrated Laparoscopic appendectomy is becoming more popular nowadays.
6
similar demographic patient presentation. However, different The decision for laparoscopic or open appendectomy depends
4
population studies conducted on pediatrics and elderly patients’ on the surgeon’s preferences and hospital facility. Laparoscopic
7
populations found no significant difference in males and females appendectomy is better than open appendectomy as it reduces
in both OA and LA groups. Since the patients were young, no surgical site infection. The other advantage of doing LA is we might
statistically significant comorbidities of patients with LA and OA be able to identify other pathology while doing the laparoscopic
groups could be observed. operation.
In a tertiary center, surgeries were mostly done by a trainee
rather than a surgeon, 88.9 vs 11.1% in the OA group and 73.3
vs 26.7% in the LA group. This is because appendicitis is among references
the most common acute surgical emergency and is one of the 1. Ghnnam WM. Elderly versus young patients with appendicitis 3
core competencies required for surgical trainees. Although most years experience. Alexandria J Med 2012;48(1):9–12. DOI: 10.1016/j.
hospitals in developed countries are managing appendectomy ajme.2011.10.004.
laparoscopically, some hospitals are still practicing open 2. Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open
appendectomy as the primary procedure for appendicitis. surgery for suspected appendicitis. Cochrane Database Syst Rev
2010;(10):CD001546. DOI: 10.1002/14651858.CD001546.pub3.
The reoperation rate in LA (0.7%) and OA (1%) group was lower 3. Park HC, Kim BS, Lee BH. Laparoscopic treatment of presumed
despite statistically insignificant data. This does not correspond perforated appendicitis in consecutive patients. Surg Laparosc
to a study done by Vahdad et al. who stated that LA had reduced Endosc Percutan Tech 2011;21(4):278–281. DOI: 10.1097/
4
8
reoperation compared to OA. Wound infection remains the SLE.0b013e318221bb23.
highest morbidity after appendectomy; however, the intra- 4. Vahdad MR, Troebs RB, Nisen M, et al. Laparoscopic appendectomy
abdominal collection is a major concern after performing operation for perforated appendicitis in children has complication rates
8
for perforated appendicitis in the pediatric population. In our comparable with those of open appendicectomy. J Pediatric Surg
study, surgical site infection was low in the LA group compared to 2013;48(3):555–561. DOI: 10.1016/j.jpedsurg.2012.07.066.
the OA group which corroborates findings in previous studies. 4,9,10 5. Markides G, Subar D, Riyad K. Laparoscopic versus open
appendectomy in adults with complicated appendicitis: systematic
Duration of surgery was longer in the LA group compared review and meta-analysis. World J Surg 2010;34(9):2026–2040.
to the OA group with a p-value of <0.001. Because most of DOI: 10.1007/s00268-010-0669-z.
the cases in both groups were done by trainees, the duration 6. Yau KK, Siu WT, Tang CN, et al. Laparoscopic versus open
of surgery was probably longer as the trainee was still in the appendectomy for complicated appendicitis. J Am Coll Surg
learning curve of the laparoscopic procedure. 10,11 2007,205(1):60–65. DOI: 10.1016/j.jamcollsurg.2007.03.017.
The average length of hospital stays in this study was 3.55 days 7. Gürleyik G, Gürleyik E. Age-related clinical features in older patients
in the LA group compared to 3.89 days in the OA group as most of with acute appendicitis. Eur J Emerg Med 2003;10(3):200–203.
DOI: 10.1097/01.mej.0000088431.19737.f8.
9
the patients were young and they progressed well after surgery. 8. Kokoska ER, Silen ML, Tracy TF, et al. Perforated appendicitis in
However, in a meta-analysis done among the elderly patients, LA children: risk factors for the development of complications. Surgery
reduced in-hospital stay compared to OA. 12 1998;124(4):619–626. DOI: 10.1067/msy.1998.91484.
Mean waiting time for surgery in our study was longer in the OA 9. Kang KJ, Lim TJ, Kim YS. Laparoscopic appendectomy is feasible for
group compared to the LA group 427 vs 320 minutes. We cannot the complicated appendicitis. Surg Laparosc Endosc Percutan Tech
explain this because we were doing studies in two hospitals and 2000;10(6):364–367.
the cases waiting for emergency surgery in each hospital were 10. Aziz O, Athanasiou T, Tekkis PP, et al. Laparoscopic versus open
different. However, most cases were managed to be done within appendectomy in children: a meta-analysis. Ann Surg 2006;243(1):
17–27. DOI: 10.1097/01.sla.0000193602.74417.14.
24 hours. Hornby et al., in their study, concluded that appendicitis 11. Tiwari MM, Reynoso JF, Tsang AW, et al. Comparison of outcome
is not more likely to lead to perforation if a short delay before of laparoscopic and open appendectomy in management
surgery is allowed. 13 of complicated and uncomplicated appendicitis. Ann Surg
We observed other advantages in the LA group that can identify 2011;254(6):927–932. DOI: 10.1097/SLA.0b013e31822aa8ea.
other pathologies, such as gynecological pathology, particularly 12. Southgate E, Vousden N, Karthikesalingam A, et al. Laparoscopic vs
in women patients, colonic tumor, and diverticular disease. open appendectomy in older patients: a meta-analysis (review). Arch
Casarotto et al. in their study among women patients suggested Surg 2012;147(6):557–562. DOI: 10.1001/archsurg.2012.568.
that the laparoscopic approach should be used in case of unclear 13. Hornby ST, Shahtahmassebi G, Lynch S, et al. Delay to surgery does
abdominal pain. 14 not influence the pathological outcome of acute appendicitis. Scand
J Surg 2013;103(1):5–11. DOI: 10.1177/1457496913495474.
Many studies were done to compare laparoscopic 14. Casarotto A, Zarantonello FR, Rebonato M. Appendectomy in women.
appendectomy and open appendectomy; however, there is still not Is the laparoscopic approach always better than the “open” approach
enough evidence to support that the laparoscopic approach is the in uncomplicated appendicitis? Surg Laparosc Endosc Percutan Tech
standard procedure for complicated appendicitis. The shortcoming 2014;24(5):406–409. DOI: 10.1097/SLE.0000000000000063.

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