Page 77 - World Journal of Laparoscopic Surgeons

WJOLS

Md Sumon Rahman 10.5005/jp-journals-10007-1331
REVIEW ARTICLE

Efficiency of Laparoscopic Appendicectomy

in Perforated Appendicitis

Md Sumon Rahman

ABSTRACT open approach needs larger incision, more tissue dissec-
Minimal access surgery is nowadays widely practiced in both tion, obscured surrounding anatomy, excessive traction
diagnosis and management of various infective conditions of by abdominal retractors, increased operation time, more
abdomen. Laparoscopic appendicectomy (LA) is a procedure of surgical stress to the patients, and, moreover, higher sur-
choice in acute or chronic appendicitis in any age group. Lapa- gical site infection rate. But several studies also assessed
roscopy is also recommended in appendicolithiasis, perforated
appendicitis, and appendicular abscess with evidence of less the role of laparoscopy in complicated appendicitis, and
morbidity and hospital stay in comparison to open approach. the results are controversial. 6-9
10
Some studies reported formation of postoperative intra- In a retrospective comparative study by Lin et al,
abdominal abscess (IAA) and challenged the laparoscopic 91 of 99 patients with perforated appendicitis were
management in perforated appendicitis. We searched through managed by LA with lower wound infection rate (15.2%)
internet for relevant articles with the keywords like LA in acute
appendicitis, burst appendix, appendicular abscess, intra- than OA (30.7%). Some study also reported the benefit of
abdominal abscess, perforated appendicitis, etc. Individual LA than OA in terms of hospital stay, antibiotic usage,
case report or case series lack in control group for comparison wound infection, resuming enteral feeding, etc., 11-13 but
were excluded from our review. some studies reported higher incidence of IAA with LA
This study reviewed the efficacy of LA in perforated 14-18
appendicitis. Parameters we concentrated were on operation in complicated appendicitis, which makes the efficacy
techniques related to operation time, conversion rate, surgical of LA in perforated appendicitis debatable.
site infection, IAA formation, hospital stay, use of analgesics,
and the cost.
MATERIALS AND METHODS
Keywords: Burst appendix, Complicated appendicitis, Intra-
abdominal abscess, Laparoscopic appendicectomy, Perforated We performed extensive literature search through
appendicitis. PubMed, Science Direct, Google Scholar, Wiley Online
How to cite this article: Rahman MS. Efficiency of Laparo- Library with the keywords: Laparoscopic appendicec-
scopic Appendicectomy in Perforated Appendicitis. World J tomy, perforated appendicitis, complicated appendicitis
Lap Surg 2018;11(1):38-42. with no definite timeline. All the articles found were
Source of support: Nil further screened and those articles including data
Conflict of interest: None representing the outcome of laparoscopic treatment of
clinically and radiologically diagnosed complicated
appendicitis were included in our review. Complicated
INTRODUCTION
appendicitis may define as clinical history suggestive of
Laparoscopic appendicectomy was first reported by acute appendicitis in which perforation with or without
1
Semm. Since then a lot of studies comparing LA vs open IAA or generalized peritonitis.
2,3
appendicectomy (OA) were performed. Minimal access Various parameters like operation time, rate of con-
technique has better visualization of the pathology and version to open, hospital stay, usages of antibiotics and
the surrounding anatomy with more accessibility in analgesics, superficial and deep surgical site infection,
comparison to open surgery. and the treatment cost were compared to evaluate the
Some authors suggested that complicated appendicitis efficacy of laparoscopy in complicated appendicitis.
4,5
could be better managed with laparoscopy because
LITERATURE REVIEWS

Assistant Professor According to the 2010 Society of American Gastroin-
Department of Surgery, Jahurul Islam Medical College & testinal and Endoscopic Surgeons (SAGES) guideline,
Hospital, Kishoregonj, Bangladesh laparoscopy is preferred in the following cases:
Corresponding Author: Md Sumon Rahman, Assistant Professor • Perforated appendicitis
Department of Surgery, Jahurul Islam Medical College & • Appendicitis in elderly and obese patients
Hospital, Kishoregonj, Bangladesh, Phone: +8801712036010 • Women of childbearing age with presumed
e-mail: drsumon@live.com
appendicitis 19
38