Laparoscopic Appendicectomy: Review of 331 Cases over 7 Years, in a Saudi Arabian Hospital

Background and Study Aims: Laparoscopic appendicectomy had been well established by Semm before the popular breakthrough of laparoscopic cholecystectomy. The aim of this study was to evaluate the role of laparoscopy in the diagnosis and treatment of acute appendicitis.
Patients and Methods: This is a retrospective study. Patients with signs and symptoms of suspected appendicitis necessitating surgery were selected for laparoscopic management between 1992 and 1999.
Results: A total of 331 patients were recruited into the study, 184 (56 %) male and 147 (44 %) female. The appendix was successfully removed laparoscopically in 98 % of the patients. The median operating time was 63.3 minutes, and 93 % of the appendices removed were histologically abnormal. Postoperative complications occurred in 19 patients (6 %), and included wound infection (1 %), enterocutaneous fistula, pelvic abscess, hemorrhage, urinary tract infection, respiratory tract infection, incisional herniae and pain at trocar sites. The mean hospital stay was 2.31 days (range 1 - 10 days).
Conclusion: Laparoscopic appendicectomy is a safe procedure with low morbidity. It is advantageous in obese patients, patients with other pathology, and patients with an unusual position of the appendix, and it has a low infection rate.

References

• 1 McBurney C. Experience with early operative interference in cases of disease of the vermiform appendix.  NY State Med J. 1889;  50 676
• 2 Semm K. Endoscopic appendectomy.  Endoscopy. 1983;  15 59-64
• 3 Neugebauer E, Troidl H, Kum C K. et al . The EAES Consensus Development Conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Consensus statements - September 1994. The Educational Committee of the European Association for Endoscopic Surgery.  Surg Endosc. 2000;  9 550-563
• 4 McMahon A J, O’Dwyer P J, Baxter J N. Laparoscopic interventions in the gut: yesterday, today, and tomorrow.  Dig Dis. 1996;  14 14-26
• 5 Lansdown M, Kraly Z, Milkins R, Royston C. Conventional versus laparoscopic surgery for acute appendicitis.  Br J Surg. 1993;  80 1349-1350
• 6 Kollias J, Harries R H, Otto G. et al . Laparoscopic versus open appendicectomy for suspected appendicitis: a prospective study.  Aust N Z J Surg. 1994;  64 830-835
• 7 Hellberg A, Rudberg C, Kullman E. et al . Prospective randomized multicentre study of laparoscopic versus open appendicectomy.  Br J Surg. 1999;  86 48-53
• 8 Scott-Conner C E, Hall T J, Anglin B L, Muakkassa F F. Laparoscopic appendectomy: initial experience in a teaching program.  Ann Surg. 1992;  215 660-668
• 9 Chung R S, Rowland D Y, Li P, Diaz J. A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy.  Am J Surg. 2000;  177 (3) 250-256
• 10 Tytgat S H, Bakker X R, Butzelaar R M. Laparoscopic evaluation of patients with suspected acute appendicitis.  Surg Endosc. 1998;  12 918-920
• 11 Anderson J L, Bridgewater F H. Laparoscopy in the diagnosis of acute lower abdominal pain.  Aust N Z J Surg. 1981;  51 462-464
• 12 Cox M R, McCall J L, Wilson T G. et al . Laparoscopic appendicectomy: a prospective analysis.  Aust N Z J Surg. 1993;  63 840-847
• 13 Vargas H I, Tolmos J, Klein S R. et al . Laparoscopic appendectomy in the 1990 s.  Int Surg. 1994;  79 242-246
• 14 Whitworth C M, Whitworth P W, Sanfillipo J, Polk H. Value of diagnostic laparoscopy in young women with possible appendicitis.  Surg Gynecol Obstet. 1998;  167 187-190
• 15 Apelgren K N, Cowan B D, Metcalf A M, Scott-Conner C E. Laparoscopic appendectomy and the management of gynecologic pathologic conditions found at laparoscopy for presumed appendicitis.  Surg Clin N Am. 2000;  76 (3) 469-482
• 16 Mutter D, Vix M, Bui A, Evrard S. et al . Laparoscopy not recommended for routine appendectomy in men: results of a prospective randomized study.  Surgery. 2000;  120 71-74
• 17 Jitea N, Angelescu N, Burcos T. et al . Laparoscopic appendectomy in obese patients. A comparative study with open appendectomy.  Chirurgia (Bucur). 1996;  45 203-205
• 18 Alvarez C, Voitk A J. The road to ambulatory laparoscopic management of perforated appendicitis.  Am J Surg. 2000;  179 63-66
• 19 McAnena O J, Austin O, O’Connell P R. et al . Laparoscopic versus open appendicectomy: a prospective evaluation [see comments].  Br J Surg. 1992;  79 818-820
• 20 Bakheit M A, Warille A A. Anomalies of the vermiform appendix and prevalence of acute appendicitis.  East Afr Med J. 1999;  76 338-340
• 21 Grandjean J P, Arefiev A. Laparoscopic appendectomy. Review based on an homogeneous series of 906 cases.  Ann Chir. 1999;  53 280-284
• 22 Attwood S E, Hill D K, Murphy P G. et al . A prospective randomized trial of laparoscopic versus open appendectomy.  Surgery. 1992;  112 497-501