European Journal of Biomedical and Pharmaceutical Sciences

THE ROLE OF EARLY LAPAROSCOPIC / OPEN APPENDECTOMY IN APPENDICULAR LUMP

*Dr. Samir Chaudhary, Dr. Vikas Adil and Prof. Dr. Shailesh Adhikary

ABSTRACT

Introduction: Acute appendicitis is the most common cause of an ‘acute abdomen’ in young adult. Advances in modern radiographic imaging have improved diagnostic accuracy. (Bailey and love 26th edition). Appendiceal mass was defined as an inflammatory mass consisting of an inflamed appendix and adjacent viscera, ranging from phlegmon to well-defined abscess (Nitecki S 1993, Meshikhes A-WN 2008, Andersson RE 2007, Simillis C 2010). The diagnosis of appendiceal mass is based on clinical examination, computed tomography (CT), trans abdominal ultrasound (US) or peroperative findings. In this modern era where facilities and expertise of laparoscopic surgery is available, laparoscopic appendicectomy for both complicated (appendicular lump) and uncomplicated appendicitis is recommended.(Ali s etal 2010, Arshad m 2011, Taj MH 2006). Materials and Method: This was prospective study done at B P Koirala Institute of Health Science for duration of one year in patients of appendicular lump presenting with in 7 days. The inclusion criteria was patients with the right iliac fossa lump consistent with appendicular lump (pre operative or intra operative) presenting within 7 days. The exclusion criteria were patients presenting after 7 days of clinical signs and symptoms consistent with appendicular lump, patients on conservative management who had to be operated due to failure of treatment beyond 7 days and patients refusing to take part. A detailed history taken from the onset of symptoms and presentation. A complete workup for operation and pre anesthetic checkup was done before the operative intervention. Laparoscopic and open appendectomy was performed. Results: A total of 35 patients were selected for evaluation over a period of one year. A total of 20 (57%) males had age ranged from 9-74 years and 15 (43%) were females, age ranging from 11–66 years. Maximum 14 (40%) patients were in the age group between 0-20 years, followed 12 cases (34%) between 21-40 years. Majority of 20 (58.8%) cases were diagnosed intra operatively by the operating surgeon and these were reported normal by ultrasonography. There were 8 (23.5%) patients diagnosed by ultrasonography and later on confirmed by the operating surgeon. 7 (17.7%) cases were diagnosed only by ultrasonography, as it was difficult to assess them clinically due to guarding and tenderness. In our study 23(65.71%) cases underwent open appendectomy while 9(25.71%) cases had laparoscopic appendectomy and 3(8.57%) need conversion to open appendectomy, due to operative difficulties. Conclusion: From our study data’s and comparison to conservative group and other study, it is clearly seems that early intervention in appendicular lump is feasible, safe with good patient compliance and less hospital stay. In our study first seven days of intervention seems safe with minimum complications. No significant difference noted in any particular day. Early surgical interference during the first admission of patients with an appendicular lump is feasible, safe and avoids the consequences of the misdiagnosis and mistreatment of other surgical pathologies.

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