Page 31 - World Journal of Laparoscopic Surgery

Perioperative Outcome of Laparoscopy in the Management of Periappendiceal Abscess
to the nonoperative approach. Other publications did not show Consent for publication: Available
any clinically important differences between the two strategies. 8 Availability of data and materials: Available
The postoperative complications are a significant issue for
urgently operated cases, with surgical site events being in up to 17%
of cases; additionally, operative intervention may result in ileocecal was secured with vessel sealing devices or clips before cutting
9
resection or right hemicolectomy. Laparoscopic appendectomy it. Amputation of the appendix was done after intracorporeal or
has acquired the favorability of many hospitals worldwide. It was extracorporeal ligature of the base and extraction using endobag
recommended by various researchers and meta-analysis, 10–12 was done. Copious irrigation with warm saline solution and lavage
to be an amenable and efficient approach, with many clinical was done based on the operator’s preference. A suction drain was
merits, like the reduced incidence of surgical site infection (SSI), left as needed. Open appendectomy was performed by making
less postoperative ileus, less postoperative pain, reduced length an Mc Burney’s incision with or without extension. Postoperative
of hospital stay, and early return to daily activities. As LA was assessment of pain was achieved using the visual analog scale
accompanied by a lowered risk of postoperative complications, it (VAS) on the first postoperative day (POD1) and analgesia was given
may represent a considerable alternative for urgent treatment of accordingly. Analgesics in the form of NSAIDs were administered
PA than IA and an urgent open approach. But there are still limited as required by patients. Intravenous fluids were administered to
studies that compare LA with OA and the development of SCs. The all patients until the return of bowel function when oral intake of
objective of this comparative activity was to perform a comparison clear fluids was started.
of the perioperative outcomes (length of hospital stay, operative
time, SCs, start to oral feeding, and return to daily work) and cost- The Variables of Patients’ Follow-up Evaluation
effectiveness in LA vs OA in these cases with PA. Data of all patients were recorded including demographic data,
clinical manifestations, intraoperative events, postoperative
MAterIAls And Methods monitoring pieces of information, and postoperative complications
(early or late).
Study Design and Patient Population Any deviation of the expected known postoperative course
A three-center observational study had been conducted, after was defined as a primary SC. Surgical site infection, recurrent
securing ethical approval from our local institutional research abscess formation, and ileus were recorded as being specific SC.
board, for the analysis of the records’ data of candidates diagnosed Readmission and 30-day mortality were the secondary ones. Also,
with PA and they had been operated on within the period from readmissions and reoperations were recorded. Incisional hernia
January 2017 until October 2020 either by laparoscopic or open and attacks of mechanical bowel obstruction were followed up as
approach. Out of 4,133 patients with AP who underwent operations a long-term specific SC.
in our institutions, 399 eligible cases with PA were identified by
clinical evaluation conjoined with the US and/or CT. These patients Statistical Analysis
were divided into the LA group (143 patients) if they had LA, and The data were collected, revised, tabulated, coded, and fed into
the OA group (256 patients) if they had an OA, solely based on the a PC using the SPSS 26 (IBM Corp., Armonk, N.Y., USA) software.
surgeon’s approach and patient criteria. The study was ethically Data were presented and suitable analyses were carried out
conducted in accordance with the Declaration of Helsinki. based on the data type gained for each parameter. Frequencies
and percentages were used for representations of categorical
Inclusion Criteria data and their comparison was accomplished using the Chi-
All patients >14 years of age with a postoperative diagnosis of square test. The mean and standard deviation were used to
a well-defined PA, which was identified by clinical evaluation represent parametric and nonparametric continuous data which
conjoined with the US and/or CT, were recruited. PA was defined were evaluated by the student’s t-test, and Mann–Whitney
if the localized abscess was present exclusively in the right U test respectively was done for using the variables mentioned
lower quadrant or extended to the pelvic region. All cases with before and was analyzed using Logistic regression to identify the
percutaneous interventional drainage, generalized peritonitis. presence of SC and their risk factors. An intention-to-treat basis
History of major open abdominal surgery, pregnancy, and severe was the cornerstone of this comparative analysis between the
medical comorbidities that preclude pneumoperitoneum were two groups. Thus, the cases in the laparoscopic-assisted group
excluded from the research. that were converted to OA were not excluded, but they were
transferred to cases of an open one. If the p-value was ≤ 0.05,
Surgical Technique it was considered statistically significant.
All patients of both groups received preoperative intravenous third-
generation cephalosporins and metronidazole. A Foley catheter results
and nasogastric tubes were inserted as needed.
All surgeries were performed by an attending senior member Demographic Data and Clinical Characteristics
(Staff or Fellow) of the general surgery department of our three The demographic and clinical features of the recruited patients
centers. The operative technique was decided according to the according to LA or OA approach are presented in Table 1. Among the
operator’s preference. LA was performed using open or closed 399 cases eligible for this study, 149 patients (37.4%) had LA. About 6
methods for pneumoperitoneum and the approach of three cases were converted from LA to the OA approach and were added
ports was performed. According to the surgeon’s preference, to the OA group. In this observational study, the demographic
an additional 5-mm port might be needed. Cautious dissection and clinical features of the study sample were very similar with
of periappendiceal adhesions was done. Suction drainage of PA no significant differences between the two groups in the gender
was completed after taking swabs. Control of the mesoappendix distribution, body mass index, comorbidities, and ASA assessment.

30 World Journal of Laparoscopic Surgery, Volume 16 Issue 1 (January–April 2023)