Evaluation of the Feasibility of Laparoscopic Appendectomy in Complicated Cases

Abstract

Acute Appendicitis is the most common Cause of Acute Abdominal Pain that requires Surgical Treatment. There is an approximately 6% to 7% lifetime Risk of developing Appendicitis. This Study was conducted upon 80 Patients from 2012 to 2014 in Ain Shams University Hospitals. Appendicitis is primarily a Disease of Adolescents and young Adults with a peak Incidence in the second and third Decades of Life which coincides with our Study as More than 50% of Patients are within this Age Group. Despite of the extraordinary Advances in modern Radiographic Imaging and diagnostic Laboratory Investigations, the Diagnosis of Appendicitis remains essen-tially Clinical requiring a mixture of Observation, clinical Acumen and Surgical Science. In an Age accustomed to early and Accurate preoperative Diagnosis, Acute Appendicitis remains an enigmatic challenge and a reminder of the art of surgical diagnosis. The use of Laparoscopy in the Diagnosis of Abdominal Diseases has rapidly expanded over the last few years. The Indications for Laparoscopy are numerous and still expanding. However, there are Several widely accepted Indications for Diagnostic Laparoscopy, Although not traditionally considered an Indication for Laparoscopy, the increasing use of Laparoscopic Appendectomy has liberalized the Laparoscopic Evaluation of right lower Quadrant pain. Laparoscopy helps diagnose the problem and, in most instances, the Treatment can be carried out using the laparoscopic Technique. As Shown in our study, most of Patients were suffering of Fever, right lower Quadrant Abdominal Pain and Tenderness, in addition to presence of leukocytosis in most of Cases of complicated Appendicitis. Also the Study highlightened the Advantages of the use of Ultrasonography as a Routine Procedure in all Cases as it was accurate in Diagnosis in about 50% of cases; also it could determine the presence of intraabdominal Collection in many cases that reflects its importance. Laparoscopic Appendectomy has become established as the Treatment of choice for Acute Appendicitis by several Studies. These Studies have demonstrated that there is less pain, shorter Hospital stay, and quicker return to full activities following Laparoscopic Appendectomy when compared with open Appendectomy. Complicated Appendicitis (defined by perforation with purulent peritoneal collection, Abscess formation, Gangrenous Appendicitis and Appendicular Mass). Laparoscopic Appendectomy for complicated Appendicitis remains controversial. Although most Studies have shown an Advantage for laparoscopic Appendectomy. As shown in our Study the Advantages of using the Laparoscopy in the Complicated Cases as regards the better Visualization and its Accuracy and also regarding Postoperative Pain, the early Return of Intestinal Sounds and Start of the oral intake and Duration of the Hospital Stay. The Feasibility and Validity of the Laparoscopic Approach has caused significant Controversy mainly due to early Reports of the increased Incidence of Intraabdominal Abscess rates. Conversely, Several more recent Trials have found a statistically significant reduction in early postoperative complications with the laparoscopic Approach to the point that it has actually been proposed as the Method of Choice for complicated Appendicitis.