LAPROSCOPIC This prospective study of 173 patients (aged

 LAPROSCOPIC APPENDECTOMY IN OBESE: AN
ATTRACTIVE OPTION

Abstract

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Background:
Laparoscopic
appendectomy is not yet unanimously considered the “gold standard” in
the treatment of acute appendicitis because of its higher operative time and
postoperative sequele as compared to open appendectomy. However its role in
overweight and obese patients should be revisited.

Objectives: This
study aimed to compare outcomes of laparoscopic and open appendectomy in obese
patients in a Tertiary care hospital.

Methods:

This prospective study of 173 patients
(aged
> or = 16 years, BMI >30)   who underwent standard laparoscopic
appendectomy(LA) and open Appendectomy(OA) from January 2013 to December 2016
in tertiary care facility. 
Patients age, gender,
operative time (OT), postoperative pain, return of bowel function, intraabdominal
abscesses, wound sepsis and  length of
stay (LOS) were compared between two groups. The test of significance used was the Chi-square test
for categorical variables and t-test for quantitative variables.

Results:
Laparoscopic
appendectomy was performed in 83 patients & open appendectomy in 90. the
mean operative time was less in the LA (52 min) as compae to OA (67 min) group.The
 rate of intra-abdominal abscess was more
in OA (11%) than LA group (3%).Similarly the post operative ileus was  less (12%) in LA then Open appendectomy(20%).
Wound sepsis was observed more in OA (9%) than LA (2%). The length of hospital
stay was shorter in laparoscopic group (2.5 days) than in open group (5 days). the
mortality rate was nil.

CONCLUSION: Laparoscopic approach is advantageous compared to open
appendectomy in terms of less postoperative pain, ileus, short hospital stay, less
wound sepsis and operation time in obese patients, but a large prospective
trial is necessary to prove the better surgical outcomes of laparoscopic appendectomy.

Key words. Laparoscopic
Appendectomy, Open Appendectomy

 

 LAPROSCOPIC APPENDECTOMY IN OBESE: AN
ATTRACTIVE OPTION

INTRODUCTION

Appendectomy is one of the commonest
surgical procedure. Despite a growing body of literature comparing results of
laparoscopic and open approaches, data has revealed inconclusive and often
contradictory. According to a Cochrane review published by Sauerland et
al.1 laparoscopy does not show relevant advantages compared to
open appendectomy, therefore indication should be limited to young women and
obese patients. Evidence supporting this theory was based on retrospective
studies2,3, administrative databases studies4,5 and
prospective trials with limited populations 6,7 therefore cannot be
considered solid enough to set laparoscopy as the gold standard procedure for
obese patients affected by acute appendicitis. Since obesity represents a
widespread condition in west and it’s a prevailing problem in our society too
so we planned this prospective study comparing open and laparoscopic
appendectomy to present data regarding the issue in our set ups.

PATIENTS AND METHODS:

This Prospective observational study included173 patients above 16 years of age with BMI 30 or greater with a preoperative
diagnosis of appendicitis who underwent laparoscopic and open appendectomy from
January 2013 to December 2016. All patients selected
by simple random sampling completed the study, including post discharge
follow-up. Patients with complicated appendicitis,
pregnant women and patients with severe medical disease (chronic medical or
psychiatric illness, cirrhosis, coagulation disorders etc.) requiring intensive
care were excluded. The variables analyzed included
patients age, gender, operative time (OT), postoperative pain, return of bowel
function, intraabdominal abscesses and 
length of stay (LOS) were compared between groups stratified by body
mass index (BMI) and operative technique. Both groups of patients were given a prophylactic dose of
third-generation cephalosporin and metronidazole at induction of the general
anesthesia as part of the protocol. OA was performed through standard McBurney
incision. A standard 3-port technique was used for laparoscopic group. All
specimens were sent for histopathology. On return of bowel sounds and passage
of flatus clear fluids were started. Patients were discharged once they were
able to take regular diet, Temperature free, and had good pain control. The
operative time (minutes) for both the procedures was determined from the skin
incision to the last skin stitch applied. The length of hospital stay was
determined as the number of nights spent at the hospital postoperatively. Wound
infection was defined as redness or purulent or seropurulent discharge from the
incision site. Paralytic ileus was defined as failure of bowel sounds to return
within 12 h postoperatively. The intraabdominal abscesses were
confirmed on ultrasound in both groups. Pain intensity was measured by visual
analogue score. All patients were given NSAIDS in routine. Narcotic analgesics
were used on demand and frequency was measured. The
results were analyzed using the t Student test for quantitative variables, and
the Chi-square test for categorical variables.

RESULTS:

173 patients (98 women and 75 men) were operated for acute
appendicitis having BMI over 30. Ninety three patients (n=93) underwent LA, 2
requiring conversion to an OA. eighty (n=80) patients underwent an OA. Demographic data between OA group and LA group are
showed in Table 1 which showed a
female preponderance. There were no significant
differences with respect to age and associated co-morbidities.

 

 

 

 

 DEMOGRAPHY (Table No.1)

Age

Male(75)

Female(98)

16-20

15

24

20-30

29

31

30-40

13

17

>40

18

26

 

POSTOPERATIVE CLINICAL DATA(Table
No.2)

COMPLICATIONS

LA

OA

P Value

WOUND SEPSIS

2%

9%

0.022

OPERAATION TIME (minutes)

52±8

67±13

0.0001

HOSPITAL STAY

3±1  days

5±1 days

0.0001

RESIDUAL ABSCESS

3%

11%

0.019

ILEUS

12%

20%

0.09

Use of Parenteral Narcotic
analgesia

29%

53%

0.0001

 

 

 

 

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