Вредноста на лапароскопската апендектомија во третманот на комплициран апендицитис

Abstract

Introduction Acute appendicitis is defined as acute appendicular inflammation which represents one of the most common surgical conditions that require operative treatment (laparoscopic and open appendectomy). The acute inflamation is represented in two forms: noncomplicated and complicated. The last one is further divided into 4 subgroups: appendicular gangrene, perforation/rupture, periappendicular abscess and secondary diffuse peritonitis. Aim This study measures the value of laparoscopic appendectomy in the treatment of complicated appendicitis through a comparation with the open appendectomy. Preoperative serum levels of Leucocyte count, CRP, total bilirubin, ALT and AST were measured; the intraoperative finding and the operative time were noted. In the postoperative period the following parameters were analyzed: the conversion rate, the correlation between the serum levels of Leucocyte count, CRP, total bilirubin, ALT and AST with the grade of intraoperative finding; overall morbidity (postoperative complications, sterile wound collections, wound infections, intraabdominal abscess occurrence); additional interventions were noted and length of stay was compared between the two groups of patients. Material and methods Operated patients with complicated appendicitis were analyzed in this prospective interventional clinical study conducted in the University Clinic “Sv. Naum Ohridski” – Skopje in the period of May 2019 – February 2021. The patients were operated with standard three-port laparoscopic technique and with the open Mc Burney access. Results Total number of 77 patients with complicated appendicitis were operated (44 laparoscopically and 33 with the open method). Positive correlation of the preoperative serum levels with the intraoperative grade is confirmed as statistically significant only for the values of CRP (p = 0.012). Operative time was statistically shorter in the laparoscopic group (67.4 ± 22.9 min. and 77.9 ± 17.9 min., p = 0.033). Overall morbidity was 25.97%. Postoperative complications occurred in 10 patients in the laparoscopic group (20.8%) and in 10 patients in the open group (30.3%). Wound infection was noted only in the open group (p = 0.018). Intraabdominal abscess occurred in one patient from the laparoscopic group (p = 0.38). There was one patient with postoperative bowel obstruction in the laparoscopic group (p = 0.38) and one patient with appendicular stump leak in the open group (p = 0.38). Length of stay was shorter in the laparoscopic group (p = 0.00009). Conclusion The method of laparoscopic appendectomy presented statistically significant advantages over the open appendectomy in the treatment of complicated appendicitis in terms of operative time, wound infection and the length of stay. Complicated appendicitis remains unexplored clinical entity that require new research studies in different medical disciplines in the future.