Outcomes of Laparoscopic Appendectomy in Eastern Region of Nepal
Author(s): Ravi Bastakoti, Adarsh Jha*, Rabin Raj Singh, Trinetra Kumar Karna, Kshitij Giri, Sunil Regmi and Atul Dwivedi
Abstract
Introduction: Acute Appendicitis is the most common intraabdominal condition which requires emergency surgical treatment. Possibility of appendicitis should be ruled out in any patient presenting acute abdomen symptoms, and a sure preoperative diagnosis is still a challenging task. There are two ways to perform appendectomy. 1. Laparoscopic Appendectomy and 2. Open Appendectomy. Recently laparoscopic appendectomy has been gaining popularity in place of open appendectomy procedure. Appendectomy is a frequent surgical procedure. All surgical procedure has their own long term and short term potential complications. The main short term complications of appendectomy such as infections and intra- abdominal abscesses. Additionally, it's also important to assess the risk of long term complications for abdominal procedures such as ileum and incisional hernia. Finally, mortality is also a complication of surgery. Appendix is a part of digestive tract, but exact function of appendix is yet to be known. Appendix may be associated with immunological function in intestine. Material and method: Total number of cases undergone LA are 62. Methods: we completed a retrospective chart review of all patients undergoing LA for a clinical presentation of acute appendicitis from 2018 to 2020. Exclusion criteria included incidental appendectomy, appendectomy of less than 16 age group. All procedure is done in our hospital. Hospital charts were reviewed and all data collected and entered in to standardized data collection forms. We randomly choose 62 patients (30 female patients, 32 male patients) Results: Length of stay in hospital 25 patients=2 days 40% 20 patients=3 days 32% 12 patients=4 days 19% 3 patients-5 day 4.8% 1 patient-6 days 1.6% 1 patient-8 days 1.6% Post-operative Complications were identified in 14 patients Wound infection: 9 cases (out of 14 cases, 9 patients with post-operative wound infection). Out of these 9 patients, 2 needed secondary suturing. These wound infections were managed by opening and packing the wound. And no intraabdominal abscess was found in any patient. Peri-operative antibiotics were given to all patients. No patient was readmitted. No mortality found so far. 3 patients developed nausea, vomiting and loose stool. Benefits: Peritoneal lavage could be done for pus in other site than RIF in 16 cases. Other pathology found 2 patients had twisted ovarian cyst. Single patient had chocolate cyst for which all 3 had undergone appendectomy and cystectomy. At the end of procedure, each patient also had extensive irrigation of the operative site. Conclusion: Laparoscopic Appendectomy is a safe technique and clinically beneficial for the patients. It provides various advantages over open appendectomy such as short hospital stay, reduced amount and duration of post-operative analgesia, early food tolerance, early return to normal activities and least post-operative complications. Contrarily, several complications may occur in this procedure too. Hence, we should assess the condition of the patient to consider laparoscopic Appendectomy as procedure of choice for most of the case of appendicitis.