Evaluation of laparoscopic appendectomy proficiency in the management of acute appendicitis based on anatomy and pathologies

Abstract

Background and objective: Laparoscopic appendectomy entered a controversial dilemma for choosing a perfect approach for appendectomy. Evaluation studies may resolve this controversy. This study aimed to evaluate laparoscopic appendectomy proficiency depending on anatomy and pathology. Methods: A total of 148cases managed by laparoscopic appendectomy were studied from 2014 to 2015.These cases were diagnosed clinically and by investigations. Parameters studied were operation duration, conversion rate, complications, associated pathology, rehabilitation, and histopathology. Results: By laparoscopy, the anatomical position of the appendix was easily recognized in 83.78%of cases, while the position of 16.22 %of cases was difficult because of the hidden appendix by adhesions, complications, and technical causes. The operation duration ranged between 34 and 60 minutes. Associated pathologies were demonstrated in 8% of cases. Regarding discharge from the hospital, 30% were on the same day, 50% on the first postoperative day, and 20% on the second postoperative day. Postoperative complications were 3% due to pelvic hematoma, port site infection, and bleeding. Postoperative pain was experienced in 3% of cases. The conversion rate was 4.7%. Rehabilitation was within 8-10 days. Conclusions: Laparoscopic appendectomy is safe and suitable for various anatomical positions of the inflamed appendix, suspicious, hidden, and in the presence of other pathologies with a properly placed port can play diagnostic and therapeutic roles. Significant superiority of laparoscopic appendectomy was observed in this study for the management of acute appendicitis and its pathological consequences. The conversion rate was 4.7% due to other pathologies. Keywords: Laparoscopic; Appendectomy; Anatomy; Pathology.