CONVENTIONAL OPEN EARLY APPENDECTOMY IN MANAGEMENT OF APPENDIX LUMP
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 50
Abstract
BACKGROUND Acute appendicitis is one of the most common causes for abdominal emergency worldwide. Its causes vary from the ones requiring medical management to those necessitating surgical intervention. Even though clinical examination and assessment are the mainstay of diagnosis, biomarker and imaging add valuable evidence. The management is also based on the clinical categories like simple non-perforated and complex gangrenous or perforated appendicitis. Clinical features include fever, raised W.B.C. count, increased C. Reactive Protein and presence of pus in abscess, but these features are by and large absent in case of lump in the appendix. In the present study, we attempted the conventional open early appendectomy in lump. The method used was examination through necked eyes and tissue contact with hands. We found visibility and cleanness to be very good than laparoscopic appendectomy in the management of appendix lump. The faster diagnosis and management are essential for the survival of patients in appendix lump. Hence, this study is under taken to study the conventional open early appendectomy in predicting the outcome. MATERIALS AND METHODS This hospital based prospective interventional study was conducted for a period of six months (October 2017 to March 2018) in the department of general surgery in F.H. Medical College and Hospital, Agra. U.P. Acute appendicitis is most common acute surgical emergency. More than 10% patients with acute appendicitis present with appendicular lump. The management of appendix lump remains controversial as some clinicians prefer conservative treatment and others go for operative procedures. This study was carried out to evaluate the outcome of conventional open early appendectomy in appendix lump. This methodology is since ancient to recent times been in practice with very successful results. 30 patients diagnosed to have appendix lump based on triple assessment (by history, clinical examination and investigations like radiological imaging and lab tests) were included and the conventional open early appendectomy was performed. RESULTS Among 30 patients included in the present study there were 20 males and 10 females ranging from 10 to 60 years. Two patients had gangrenous adhesions in caecum for whom, ileocaecal anastomosis was done. Abdominal cavity was cleaned, and drain was placed for 3 to 4 days. The operative time was 60 minutes to 120 minutes. The hospital stay in 2 patients was 15 days and in remaining 20 patients was 7-10 days. No major post-operative complications were noted. Only 2 patients developed complications which were treated spontaneously by dressing and higher antibiotic medication. In the present study, the overall success rate was 98% and 2% developed complications. CONCLUSION Conventional open early appendectomy is feasible and safe in secondary care hospitals than laparoscopic appendectomy. The conventional open early appendectomy avoids the need for readmission and also avoids misdiagnosis. This procedure has been performed under the naked eye-vision and direct touch to tissue by the head-heart-hands involvement. This method is associated with less morbidity, mortality
Authors and Affiliations
Amanjee Bharti, Ram Nagina Sinha, Anuradha Sharma, Pallavi Kumari, Kumari Neha
Keywords
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- EP ID EP550466
- DOI 10.14260/jemds/2018/1193
- Views 105
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