Laparoscopic Treatment of Perforated Appendicitis

Abstract

The most frequent general surgical emergency worldwide is acute appendicitis. Because to its potentially fatal complications, including perforation, it could put patients at danger of death. An appendix that has ruptured frequently results in serious infectious complications as abdominal sepsis, pelvic abscess, and others. Laparoscopic appendectomy for perforated appendicitis raises several questions. In many nations today, laparoscopic treatment of perforated appendicitis is the preferred surgical technique.

Aim: This prospective study's objective was to assess the efficacy of laparoscopy in the treatment of complicated appendicitis (perforation).

Methods: The study was conducted prospectively during the period from September 2020 to August 2022. The study included 50 individuals who underwent peritoneal lavage after laparoscopic appendicectomy of perforated appendix in the department of Surgery, Lady Reading Hospital, Peshawar. The traditional method, three ports technique was used. Sometimes a fourth port is needed. Telescopic ports are 10 mm in size. The other two ports are 3/5 mm and 5/10 mm, respectively. Unipolar diathermy is a source of energy. Hemostasis and ligation of the appendicular stump are achieved via intra-corporeal knotting, endo-loop, and hemo-clip.

Results: The study's age range is 5-70 years, with a mean age of 19 with male predominance. The duration of surgery varies from 30 to 120 minutes, with a mean duration of 65 minutes. Hospital stays range from 48 to 96 hours on average. There were 12 patients with complications, including paralytic ileus was seen in 1(2%), diarrhea in 2(4%), multiple or single (4% and 8%) port infections, and port TB in (4%). Open conversion was seen in 1 (2%) patient due to appendicitis burst haemorrhage. Every complication was treated carefully.

Conclusion: Laparoscopy is an excellent method for treating perforated appendicitis. Thus, it is practical, achievable and may be carried out by skilled hands in any centre. That is now regarded as regular operating procedure.

Keywords: Laparoscopic appendicectomy, Perforation (burst)