Peroperative Indications for Conversion of Laparoscopic Appendicectomy to Open Appendicectomy
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 10
Abstract
Appendicitis is the most common intra-abdominal condition requiring surgery, with a lifetime risk of 6%. Appendicectomy, one of the commonest procedures in general surgery accounts for about 2%. Though the open technique of Appendicectomy was described by McBurney in 1894 continued to remain the treatment of choice, the first ever laparoscopic Appendicectomy performed by Semm in 1983 paved the way for its widespread global acceptance over the open technique. It combines the advantage of diagnosis and treatment in a single procedure. Moreover it has many advantages than open procedure which is dealt in our study. Objectives The various preoperative findings which necessitate conversion of laparoscopic Appendicectomy to open and the advantages of laparoscopy over conversion to open with respect to the following where studied: • Post operative pain and duration of analgesic use • Length of hospital stay • Return to work. Review Of Literature Laparoscopic and minimal access surgery continues to expand in the field of general surgery, and diagnostic laparoscopy and laparoscopic appendectomy have become accepted procedures in many surgeons’ practices. The early use of diagnostic laparoscopy in patients with right lower quadrant abdominal pain and suspected appendicitis reduces the risk of appendiceal perforation and the negative appendectomy rate to less than 10%. Diagnostic laparoscopy is particularly useful in women of reproductive age and in the obese. In the former, frequently confounding gynecologic disorders can be well visualized to provide the diagnosis, and in the latter, laparoscopy can eliminate the morbidity risks of a large incision. Performing an appendectomy with a normal-appearing appendix has a relatively low risk and will remove appendicitis from the differential diagnosis of right lower quadrant pain in the future. However studies have shown that it is safe to not proceed with appendectomy if the appendix appears normal. Conversion of diagnostic laparoscopy to therapeutic laparoscopy is easily accomplished by the addition of other ports. Trocar placement for laparoscopic appendectomy is a matter of surgeon choice with consideration of the triangle rule for port placement. Diagnostic laparoscopy is usually performed through a periumbilical port, with a 10/11-mm port added midway between the umbilicus and pubis and a 5-mm port placed over the appendix or the right midlateral abdomen if appendectomy is performed . Once the diagnosis is confirmed, the mesoappendix can be taken down with either hemoclips or the Harmonic Scalpel. The appendix is amputated from the cecum between endoloops or with an endo-GIA stapler. The appendix can then be removed from the abdomen with a specimen pouch or withdrawn into the 10/11- mm port. Care should be taken to prevent contact of the appendix or its contents with the wound edges. There is general agreement that patients undergoing laparoscopic appendectomy have less postoperative pain, a lower rate of wound infection, a lower overall complication rate, a more rapid return to diet, a shorter hospital stay, a longer operative time, and more equipment charges in the operating room. In contrast, a more rapid return to work and a lower complication rate are more controversial claims because prospective studies show differing results. Laparoscopic appendectomy results in a lower wound infection rate compared with an open procedure but have a higher intraabdominal abscess rate if the appendix is perforated. Relative contraindications to laparoscopic appendectomy include previous abdominal surgery precluding safe trocar placement, uncontrolled coagulopathy, and significant portal hypertension. Laparoscopic appendectomy appears to be safe and efficacious. It provides a rapid diagnosis and a significant reduction in negative appendectomy rates in females of childbearing age with suspected appendicitis. Minimal access surgery reduces the morbidity risk in obese patients who require an appendectomy.
Authors and Affiliations
Prof Dr. K Shanthakumar
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