Page 8 - World Journal of Laparoscopic Surgeons

Hesham Kasem, Wael Alshahat
lavage was done and closed suction drain was inserted Table 2: Operative time and postoperative course
in the pelvis. Variable LA OA p-value
Open appendectomy has been done through right Operative time (min) 59.6 ± 20.3 62.8 ± 28.6 >0.05 NS
lower quadrant incision with muscle cutting when Length of hospital stay 3.5 ± 2.6 5.8 ± 2.9 >0.05 NS
required. Postoperatively, intravenous ceftriaxone 50 (days)
to 100 mg/kg once daily, and metronidazole 10 mg/ NS: Nonsignificant
kg/8 hr were given until fever subsided and the white Table 3: Postoperative complications
blood cells count decreased, and the patients were dis- Variable LA OA p-value
charged when they can tolerate feeding and no fever and Wound infection 2 (4.5%) 3 (8.1%) <0.05
continued on oral antibiotic cefixime 7 mg once daily Abdominal infection 0 2 (5.4%) <0.05
and metronidazol oral 10 mg/kg/8 hr for 1 week. All Adhesive intestinal obstruction 0 1 (2.7%) <0.05
appendices were sent for histopathology. Pus was sent Readmission 0 2 (5.4%) <0.05
for culture and drug sensitivity. They were followed up Total 2 (4.5%) 8 (21.6%) <0.05
in the outpatient clinic 5 days after their discharge from
the hospital. Perforated appendicitis has been diagnosed 8.1.5%; p < 0.05). The occurrence of the intraabdominal
by the presence of pus either localized or generalized or abscess was significantly lower in the LA group (0 vs
the presence of visible perforation or fecalith operative 5.4%; p < 0.05).
time was calculated from the end of the anesthesia till
the end of the suturing. DISCUSSION

RESULTS Open appendectomy has been done through muscle
splitting right lower quadrant incision since long time,
Eighty-one children who underwent appendectomy but recently, LA appendectomy has been increasing, and
for perforated appendicitis between January 2013 and some surgeons perform it routinely, others select cases,
October 2016 were included in the study among 81 and some others still do it open. The advantages of LA
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patients of whom 53 were male and 28 were female; 44 include short hospital stay, less postoperative pain, good
children underwent LA and 37 had OA. The demographic exploration of the abdomen, fewer complications, but
characteristics are shown in Table 1. The majority of its routine use in complicated appendicitis is still con-
the patients were male. This difference was statistically troversial. The operative time depends on the surgical
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significant (p < 0.05). There was no difference between skills and the degree of inflammation of the appendix.
LA and OA groups with respect to mean age (p > 0.05). Although LA surgery takes time for preparation, and
The median operative time in the LA group was 51.6 ± connection of the tubes and also working in a small
20.3 minutes, compared with the OA group (62.8 ± 28.6 space provide some difficulties and require meticulous
minutes). There was no difference (p > 0.05). There was no introduction of the instruments, OA also takes time
conversion to open in the LA group. The histopathology for opening and closure of the abdomen, especially in
in the OA group was acute suppurative appendicitis in obese patients and if muscle cutting was done. In our
29 patients and gangrenous appendicitis in 15 patients, study, we did not observe any difference in the operative
and in the LA, in 25 patients, it was acute suppurative time between open and LA group; this is mainly due to
appendicitis and in 12 patients, it was gangrenous appen- increased surgical experience in LA surgery. Also in a
dicitis. A significant difference was found as regards the study done by Li et al, there was no difference in the
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duration of hospitalization between OA and LA; it was 3.5 operative time. Some studies also reported no differ-
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± 2.6 vs 5.8 ± 2.9 days (p < 0.05). We had 7 children (13.6%) ence in the operative time. 4,6,11 And some other studies
who developed postoperative complications in the LA reported increased operative time for LA compared
group and 17 patients (45.9%) in the OA group (Tables 2 with OA in perforated appendicitis. During LA, intra-
7-9
and 3) with significant difference, p < 0.05. Children in operative complications can occur as visceral injury or
the LA group had a lower rate of wound infection (4.5 vs.
parietal bleeding during trocar insertion. In one study,
the incidence of bowel injury during LA was reported
Table 1: Patient’s demographics
to be 0.8% and this injury can occur due to dissecting of
Variable LA OA p-value the inflamed friable bowel or dissecting at the base of the
Number 44 37 NS appendix. In our study, we did not encounter any bowel
Age 7.6 (3–14) 8.2 (5–14) NS 10
Sex (male:female) 30:14 23:14 <0.05 injury. Bleeding also can occur during LA which is due
(68.1:31.8%) (62.1:37.8%) to improper control of mesoappendix. The reported inci-
NS: Nonsignificant dence of bleeding from mesoappendix in LA in a large
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