Department of Surgery, BIRDEM General Hospital, Dhaka, Bangladesh
and Objective: Currently,
laparoscopic appendectomy (LA) is widely practiced for the management of acute
appendicitis (AA). The application of laparoscopic technique for appendectomy
is expanding very rapidly and now performed in almost all major cities and
tertiary level hospitals. This study addressed to determine the outcomes of
laparoscopic appendectomy in our surgical setup at Bangladesh Institute of
Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM).
All admitted patients at BIRDEM hospital and clinically diagnosed as acute
appendicitis considered eligible for the study. Based on clinical history relevant
and routine biochemical investigations were done. A board of experienced
surgeons selected the eligible cases for LA. The study continued from Sept 2014
to Sept 2016.
A total of 47 (M / F = 21 / 26) patients with acute appendicitis were admitted
during this period. The mean (SD) age was 21 (±1.4) years in male and 19 (±1.7)
years in female. The mean age of the total patients was 20 (±1.6) years. Eighty
percent of the patients were of age 30 years or less. Per-operative
laparoscopic findings revealed that five cases (10.6%) were misdiagnosed as appendicitis.
Two (4.2%) cases were found to have other pathology and necessitated open appendectomy (OA). One was suspected for malignancy
and other had appendicitis with adhesion. Overall, four important post-operative
outcomes were observed: (a) post-operative pain was found reducing gradually
and it fell below pain score 2 or even less after 30 hours; (b) port-site bleeding
and infection were observed in 4.3% and 2.1%, respectively; (c) none had
visceral bleeding or subcutaneous emphysema and (d) more than 80% were
discharged within 72 hours.
Most of the patients admitted with acute appendicitis were of younger age
(<30 years). Though there was no comparative group undergoing open
appendectomy (OA), it was apparent that laparoscopic approach was proved to
have reduced pain, less complication and shorter hospital stay thus reducing
the treatment cost. Thus, LA was found relatively safe and resilient procedure.
An additional benefit of laparoscopy was that it revealed about 10% case were
misdiagnosed as having appendicitis. Thus, this approach may be considered as a step forward in the treatment of appendicitis making easier to explore the abdominal cavity while
keeping an option to perform an OA.
IMC J Med Sci 2017; 11(1): 15-18
Address for Correspondence: Dr. Tapash Kumar
Maitra, Associate Professor & Head, Department of Surgery, BIRDEM General
Hospital, 122 Kazi Nazrul Islam Avenue,
Shahbag, Dhaka, Bangladesh. Email: email@example.com