English

Abstract

BACKGROUND: The aim of this study was to evaluate the safety, feasibility, and cosmetic result of a novel approach i.e. conventional appendectomy via the trans umbilical route using routine open surgery instruments. PATIENTS AND METHODS: This retrospective study included 40 selected cases during period from Jan 2011 to April 2013 in Shimoga Institute of Medical Sciences, Shimoga, Karnataka. Inclusion criteria were a thin built patient with lax abdominal wall, acute classical presentation in early stage of appendicitis, cases posted for interval appendicectomies, recurrent attacks of appendicitis or appendicular dyspepsia and also patients with positive clinical, laboratory and clear cut ultrasonography findings. Excluded from study group were those patients who presented few days later after acute attack, or with complications of mass formation /abscess, undiagnosed obscure causes of RIF pain with no classic history or findings and patients with pelvic peritonitis. RESULTS: Conventional appendicectomy was safely performed in 32 out of 40 cases studied, through single incision trans umbilical route. In remaining 8 cases an additional right iliac fossa incision with muscle cutting had to be employed for dissection of adhesions and retrocaecal /subhepatic positions of inflamed appendix and auto appendectomy with fecolith dislodgement which was observed intraoperatively in 2 cases. The calculated conversion rate was about 20 %. The mean operative time was almost same compared to routine surgery by Mc Burney incision (25 min v/s 22 min). The average hospital stay was 4 days. All patients were followed up for 3-6 months. 8 cases reported with seroma and mild infection from umbilicus which resolved spontaneously with conservative treatment. The estimated infection rate was 9 % in our study. None of the patients had any incisional hernia postoperatively. CONCLUSION: Although Laparoscopy has largely superseded open surgery in diagnosis and treatment of acute appendicitis, open surgery with minimal invisible scar can still be undertaken at primary and secondary care level cost effectively with conventional open surgery instruments, by this novel technique in properly selected cases.