Page 34 - World Journal of Laparoscopic Surgery

Perioperative Outcome of Laparoscopy in the Management of Periappendiceal Abscess
In this study, the population was divided into two groups LA group with a statistically significant difference (p = 0.032) with a
according to the operative approach. The laparoscopic group (LA) superior conjoined early recovery of gastrointestinal function and
included 143 patients. The open group (OA) included 256 patients. intestinal motility, which subsequently led to an earlier start of oral
No statistical significance was observed between the patients of the intake and return to home.
two groups regarding the sex difference, age, BMI, ASA grading, or Despite the recruited candidates being different, our results are
associated comorbidities. coping with various research that reported a statistical significance
The clinical characteristics of the study population, including of short LOS for the LA group. 35–37 The applicable reasons for these
major symptoms, duration of symptoms prior to admission, body results might result from the minimal surgical trauma of laparoscopy
temperature at the time of admission, and the number of leukocytes and little manipulation of the ileocecal area by an experienced
showed no statistical significance between cases of the two groups. skillful physician during laparoscopy, and less postoperative pain
As regards the operative findings, with a p-value of more than owing to the limited extension of the surgical wounds.
0.05 in the operative blood loss, the need for drain application, In the surgical field, despite the aforementioned merits, open
and failed appendectomy, they were statistically insignificant. surgery is still widely accepted because of the issues of possible
During the clinical follow-up period, 12 out of 15 cases of failed longer operating duration, higher expenses, and in some hospital
appendectomy in the study population were passed with no further settings, the absence of equipment and expert surgeons for the
experience of recurrent attacks; hence, they did not have an interval LA approach. In general, the long operative time is mostly due to
appendectomy. About three cases had interval OA following the insufficient skills of surgeons, such as handling of the instruments,
recent attack after variable periods of 6–12 months. pneumoperitoneum, and careful monitoring of ports under vision
The role of routine IA is currently debatable. Even in cases during the operative time. 38,39
with localized PA formation, IA is not mandated after successful Our institutions have a satisfactory experience with the LA
conservative treatment. The incidence of recurrent attacks of AP approach for the cases of PA. For the last 6 years, laparoscopy was
is low and at that time, removal of the appendix can be safely mostly preferred for the management of cases of PA. Our rate of
performed. 23,24 the switch to OA was only 4.7%; this result pointed to the well-
The open group involved lesser operative time than did the gained experience of the laparoscopic approaches in our institutes.
laparoscopic group, as the average operating time for the LA group Moreover, advanced training in laparoscopic techniques was spread
was 78.9 ± 28.4 minutes (range: 65–160 minutes), whereas, for the worldwide, leading to a noticeable reduction in the difference in
open group, it was 62.1 ± 23.6 minutes (range: 45–145 minutes) the operative time.
with a p-value of less than 0.016 by t-test, which was statistically The present research concluded a noticeably reduced incidence
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significant. Nearly similar findings were obtained by Quezada et al. of specific surgical events after the laparoscopic approach for cases
with longer operative time for the LA group. This may be attributed of PA. We observed a decreasing rate of salient SCs with 24.2%
to the time taken for the peritoneal irrigation, suction, lavage, and (62/256) and 26.6% (38/143) for open approach and laparoscopic
securing of the appendicular stump. 26,27 approach, respectively. This finding agrees with the net results
27
The rate of conversion was 6 out of 149 patients of LA and they of a recent scientific meta-analysis, which points to AP in the
were transferred to the other group (OA), reaching 4.7%, which adult population. SSI is frequent in complicated AP; however, it
was within the range compared with other studies. 25,28 In this is not a serious event but has a considerable effect on the early
research, the mean operative time was in favor of the OA group postoperative period of recovery and the quality of life.
with a significant difference of 16 minutes, which was observed to The significant reduction of SSI rate becomes a major advantage
2
be of statistical significance. As in the case of PA, the meticulous of laparoscopy techniques. In the LA group, 18 (12.6%) patients had
dissection and safe appendectomy were practically challenging and SSI, whereas in the open group, 27 (10.5%) patients had SSI; similar
time-consuming. The average rate of the switch to open approach results have been reported in other series. 27
was due to dense adhesions, mainly severe inflammatory reaction, In the laparoscopic group, 2 (1.4%) patients had an incisional
and even more challenging difficult dissection. hernia, whereas in the open group, 12 (4.7%) patients had an
The key point that directly affects the general status of the case incisional hernia. This emphasizes the advantage of the laparoscopic
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and the economic issue is lowered hospital stay, which stemmed approach in preventing SSI and incisional hernia in septic
from the earlier start of oral feeding, diminished SCs, and so a operations as in complicated appendicitis. Despite, the definite
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faster return to daily activity. The characteristic pros of the reason is hard to touch in the clinical setting of contaminated
laparoscopically managed patients of PA over the traditional open surgery, the lower rate of SSI in LA may result from the tiny incisions
surgery contain the aforementioned merits, which were proved of the laparoscopic approach, and specimen retrieval inside the
by late meta-analysis, which concluded that cases with LA return plastic endopouch lowers the probability of SSI. Since this method
quicker to daily activities. 30,31 clarifies the surgical site issues frequently incurred from the
Our findings included closely recorded variables, with ongoing conventional approach, it is highly beneficial that skillful physicians
monitoring of gastrointestinal motility and close assessment by can do the highest percentage of these surgeries via a laparoscopic
nurse staff, which could be performed continuously in our hospital approach despite the abscess.
settings. So, any postoperative gastrointestinal complaints would The recurrence of a postappendectomy intraperitoneal
be recorded in the eligible cases. collection is a terrible life-threatening specific SC. We reported
Patients in the laparoscopic group needed less analgesia 32,33 as recurrent intra-abdominal collection in 6 (4.2%) cases and 4 (1.6%)
the p-value was 0.024, with the early return of bowel habits and the cases in the LA group and OA group, respectively (p = 0.37). there
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early start of oral feeding. They also had a shorter hospital stay was a significant risk of recurrent intra-abdominal collection after
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(6.3 vs 7.4 days) and early return to normal activities (13.5 vs. 17.1 LA, which was published in a recent meta-analysis. But our results
days, p = 0.015) compared with the cases in the OA group. Also, we agreed with other publications and the most updated research
reported that the LOS at the hospital was shorter in cases with the that proved a reduced incidence of intraperitoneal collections,
World Journal of Laparoscopic Surgery, Volume 16 Issue 1 (January–April 2023) 33