Effects of emergent laparoscopic appendectomy on pancreatic endocrine function of patients with acute suppurative appendicitis combined with type 2 diabetes mellitus

Abstract

Objective To explore the effects of emergent laparoscopic appendectomy on pancreatic endocrine function of patients with acute suppurative appendicitis combined with type 2 diabetes mellitus. Methods The clinical data of 76 patients with suppurative appendicitis combined with type 2 diabetes mellitus who were admitted to the Yongchuan Hospital of Chongqing Medical University between October 2012 and October 2014 were retrospectively analyzed. Among the 76 patients receiving emergent appendectomy, 41 patients receiving laparoscopic appendectomy were allocated to the laparoscopy group and 35 patients receiving open appendectomy were allocated to the open surgery group. The intraoperative conditions of patients were observed. The levels of serum C-peptide, insulin and blood glucose at preoperative minute 15 (t1) , intraoperative minute 15 (t2) , intraoperative minute 30 (t3) and postoperative minute 30 (t4) were detected by enzyme-linked immunosorbent assay (ELISA) . The recovery indicators of patients were analyzed. The patients were followed up by telephone interview till December 2014. Measurement data with normal distribution were presented as ±s. Comparison between groups was analyzed by the independent samples t-test and repeated measures ANOVA. Count data were compared by the Fisher exact probability. Results All the patients underwent successfully the operations. The operation time and the volume of intraoperative blood loss in the laparoscopy group were (50 ±7) minutes and (8. 4 ±3.4) mL, which were not significantly different from (52 ±7) minutes and (7.7 ±2. 9) mL in the open surgery group (t =1.291, 1.042, P >0.05) . Serious adhesions of tissues around the appendix in the laparoscopy group were detected in 8 patients, which was not significantly different from 11 patients in the open surgery group (P >0.05) . The results of the serologic test showed that the levels of serum C-peptide between t1 and t4 were (62. 5 ±3.3) μg/ L, (70. 7 ± 2. 9) μg/ L, (86. 5 ± 3.4) μg/ L and (68.1 ± 2.6) μg/ L in the laparoscopy group and (63.8 ± 2. 8 ) μg/ L, (95.6 ±5. 1) μg/ L, (106. 6 ±2.3) μg/ L and (67.5 ±4.9) μg/ L in the open surgery group, respectively. The levels of insulin between t1 and t4 were (13.1 ± 1.0) mU/ L, (14.0 ±1.1) mU/ L, (15.1 ± 1. 2) mU/ L and (13. 5 ± 1. 1) mU/ L in the laparoscopy group and (13. 3 ±0. 4) mU/ L, (15. 4 ±0. 6) mU/ L, (18. 2 ±0.7) mU/ L and (13.5 ±0. 4) mU/ L in the open surgery group, respectively. The levels of blood glucose between t1 and t4 were (7.8 ±1.0) mmol/ L, (8.3 ± 1.0) mmol/ L, (8.9 ± 1.0) mmol/ L and (8.1 ± 1.0) mmol/ L in the laparoscopy group and (7.8 ± 0.4) mmol/ L, (8.7 ± 0.5) mmol/ L, (10.1 ± 0.4) mmol/ L and (7.9 ± 0. 5 )mmol/ L in the open surgery group, respectively. There were significant differences in the changing trends of serum C-peptide, insulin and blood glucose between the 2 groups (F =378.917, 286.602, 118.199, P 0.05) . The duration of postoperative abdominal pain in the laparoscopy group was(1. 5 ±0.6) days ,which was significantly different from (2.5 ±0. 7) days in the open surgery group (t =-6.367, P <0.05) . The wound infection and fever in the laparoscopy group were detected in 6 and 10 patients, which were significantly different from 14 and 22 patients in the open surgery group (P <0.05) . The duration of hospital stay in the laparoscopy group and in the open surgery group were (5.2 ± 0.4) days and (6.3 ± 0.8) days, respectively, showing a significant difference between the 2 groups (t =7.796, P <0.05) . All the patients were followed up for a median time of 8 months (range, 2- 18 months) , without adhesive intestinal obstruction, abdominal pain, abdominal distension and appendix stump inflammation. Conclusion The emergency laparoscopic appendectomy compared with the open surgery would be less affected on pancreatic endocrine function of patients with acute suppurative appendicitis combined with type 2 diabetes mellitus, with an advantage of better postoperative recovery. Key words: Appendicitis; Diabetes mellitus, type 2; Laparoscopy