Postoperative Outcome of Laparoscopic Appendicectomy-A Study of 100 Cases

Background : An elegant, reliable procedure that can be easily performed is laparoscopic appendicectomy (LA). In patients with undiagnosed abdominal pain requiring more diagnostic investigations, as well as in patients with perforated appendicitis with or without intra-abdominal abscess, this procedure remain useful and safe. Objective : To evaluate the postoperative outcome and complication in laparoscopic appendicectomy. Methods : This prospective observational study was conducted at Rezia Taleb Hospital, Dhaka in Bangladesh. Total 100 cases were included in this study during the period of January 2018 to December 2019. Total 100 admitted uncomplicated acute appendicitis patients who underwent LA were enrolled in this study. Diagnosis is based on patient history (symptoms) and physical examination with an elevation of neutrophilic leukocytosis and raised CRP. In this study inclusion criteria of the cases were- Age <40 years, Alvarado Score 7 or more, Uncomplicated appendicitis, patients who underwent LA for appendicitis, both sexes. Exclusion criteria were - Incidental LA, patients with significant co-morbid medical conditions, patient unwilling to incorporate with the protocol, patients with psychiatric illness, and who lost to follow-up. Results : Out of 100 patients, most of them 63(63%) were in age group <20 years. The mean age was 21.70±6.21 years. Majority 77(77%) were male and 23(23%) were female and male: female ratio was 3.3:1. Among the 100 respondents, majority 95(95%) presented with migratory right iliac fossa pain and 5 (5%) had early postoperative complication. Majority 95(95%) patient’s pain control occurred within1-2 days with NSAID. Out of 95 Uncomplicated patients; Length of Hospital stay was 1-2 days in 90(94.7%) and 3-4 days in 5(5.3%) cases. Conclusion : This study showed that laparoscopic appendicectomy had found to be associated with shorter hospital stay, decreased postoperative pain and wound infection.

open appendicectomy, and have less postoperative morbidity in experienced hands. 3 Laparoscopy, particularly in female patients with abdominal pain of unknown origin, can provide benefits in terms of accurate diagnosis. In patients with acute abdominal pain to differentiate whether there is a normal appendix or recurrent appendicitis, need improve accuracy of diagnosis. 4 LA was associated with reduced postoperative pain following surgery, a lower risk of wound infections, and faster healing periods. LA for acute appendicitis has been extremely common surgery over the past decade. 5 The aim of our study was to evaluate the post-operative outcome of LA.

Introduction
One of the most common causes of abdominal pain and surgical emergency was acute appendicitis. Appendicectomy is one of the commonest procedures in surgical practice. McBurney done the 1 st open appendicectomy in 1889, since then it has been the gold standard for more than 100 years for the treatment of acute appendicitis. 1 Over the past few years, laparoscopic appendicectomy (LA) has been widely used to treat acute appendicitis. The often-cited benefits are decreased postoperative pain, earlier diet resumption, earlier return to work, and less wound infections. 2 LA is a secure operation, like Abstract Background : An elegant, reliable procedure that can be easily performed is laparoscopic appendicectomy (LA). In patients with undiagnosed abdominal pain requiring more diagnostic investigations, as well as in patients with perforated appendicitis with or without intra-abdominal abscess, this procedure remain useful and safe.
Objective : To evaluate the postoperative outcome and complication in laparoscopic appendicectomy.
Methods : This prospective observational study was conducted at Rezia Taleb Hospital, Dhaka in Bangladesh. Total 100 cases were included in this study during the period of January 2018 to December 2019. Total 100 admitted uncomplicated acute appendicitis patients who underwent LA were enrolled in this study. Diagnosis is based on patient history (symptoms) and physical examination with an elevation of neutrophilic leukocytosis and raised CRP.
In this study inclusion criteria of the cases were-Age <40 years, Alvarado Score 7 or more, Uncomplicated appendicitis, patients who underwent LA for appendicitis, both sexes. Exclusion criteria were -Incidental LA, patients with significant co-morbid medical conditions, patient unwilling to incorporate with the protocol, patients with psychiatric illness, and who lost to follow-up.

Conclusion :
This study showed that laparoscopic appendicectomy had found to be associated with shorter hospital stay, decreased postoperative pain and wound infection.  Among 100 respondents 77(77%) patient were male, 23 (23%) were female and male: female ratio was 3. In our study, majority of the patients presented with migratory right iliac fossa pain 95(95%) whereas 5(5%) presented with localized right iliac fossa pain. (Table II) We found that total 5(5%) patient had early post-operative complications (Umbilical port site infection, Pelvic abscess). Among them 3(3%) had umbilical port site infection and 2(2%) patient had pelvic abscess. (Table III)  Umbilical port site infection 3 3 Pelvic abscess 2 2

Total 5 5
In our study, 95(95%) patients required NSAID for 48 hours and only 5(5%) needed NSAID for postoperative pain management for more than 48 hours. (Table IV)  Among 95 uncomplicated patients, most of the 90(94.7%) patients were discharged within 1-2 days from the hospital and

Materials and methods
This prospective observational study was performed between January 2018 and December 2019 at Rezia Taleb Hospitals, Dhaka, Bangladesh, with 6 months of follow-up after surgery.
Total 100 admitted uncomplicated acute appendicitis patients who underwent LA were enrolled in this study. Diagnosis is based on patient history (symptoms) and physical examination with an elevation of neutrophilic leukocytosis and raised CRP. The typical symptoms of acute appendicitis are poorly localized periumbilical pain associated with anorexia, nausea, one or two episodes of vomiting. Low-grade pyrexia, localized tenderness in right iliac fossa, muscle guarding and redound tenderness are the cardinal clinical sign. 6 Inclusion criteria: 1) Age <40 years, 2) Alvarado Score 7 or more, 3) Uncomplicated appendicitis, 4) Patients who underwent LA for appendicitis, 5) both sexes.
Exclusion criteria:1) Incidental LA, 2) Patients with significant co-morbid medical conditions, 3) Patient unwilling to incorporate with the protocol, 4) Patients with psychiatric illness, 5) Lost to follow-up. All the study population were undergoing LA by the following surgical procedure.
Surgical procedure: Standard preoperative preparation was used. After induction of general anesthesia, the patient remains in the supine position on the operating table.
Pneumoperitoneum was then established, A 10-mm trocar and cannula then introduced through the umbilicus. The camera was then introduced via the umbilical cannula. Laparoscopic examination of the entire abdomen was first performed to rule out other pathology, Additional two 5-mm trocars and cannula were brought in under direct vision in the mid left lower quadrant, and suprapubic or right lower quadrant position. The appendix was then mobilized. An opening was made into the mesoappendix at the base of the appendix, and the mesoappendix was divided with a Harmonic scalpel. The base of the appendix was divided between hem-o-lok clip or endoloop. The specimen removed through the 10-mm cannula site. After removal, the operative site was inspected, and umbilical port was sutured. Ceftriaxone and metronidazole were used throughout the postoperative period. Post-operative pain was managed with NSAID. Post-operative complications were managed accordingly.

Result
The total number of 100 uncomplicated appendicitis patients were included in this study. Majority of patient 63 (63%) were in age group ≤20 years followed by 26(26%) were in age group 21-30 years. The mean (±SD) age was 21.70±6.21 years. (Table I

Discussion
The adoption of laparoscopic procedures in general surgery has been the single largest advancement in surgical practice in the last two decades. A greater concern in the 21 st century is patient satisfaction. Different studies have shown that the laparoscopic method could be applied to most cases of appendicitis with high degree of success and low complication incidence. 7 Therefore, this procedure achieve greater patient's satisfaction also.
In the present study out of 100 respondent 63% patients were in age group of <20 years followed by 26% were in age group between 21-30 years and mean age was 21.70±6.21 years. Among all respondents 77% were male and 23% were female and their ratio was 3 In our study, there was umbilical port infection (3%). Pelvic abscesses formation rate was also lower (2%). The risk of wound infection is less in laparoscopic appendicectomy. A randomized controlled trial has been reported with outcomes of 2877 patients included in 28 trials was done by Katkhouda N et al. where wound infections were definitely reduced (2.3%), which was similar to our study. 10 We found that post-operative pain was significantly less in LA; Khalil et al. found significant less postoperative pain in LA. 11 In our study the length of hospital stay is presumed to be shorter which is consistent with Hansen JB et al. Kumar