الملخص الإنجليزي
Objective: The laparoscopic appendicectomy can be performed
using one to several ports. We present our experience of two port
laparoscopic assisted open appendicectomy. The objective was to
assess the results retrospectively in terms of complications and its
limitations.
Methods: Between years 1998-2007, a two port laparoscopic
assisted appendectomy was attempted in 2380 adult patients with
suspected appendicitis. The patients with localized or generalized
peritonitis were included. The appendicectomy was performed via
an assisted two port method using 10 mm umbilical optical port
and another 10 mm port in right iliac fossa. The children aged 12
and below and pregnant patients were excluded. All patients had
their laparoscopic appendicectomy within 48 hours of admission.
Results: Two port laparoscopic assisted appendicectomy was
successful in 86.9% of cases. Acute appendicitis was the cause of
acute abdomen in 88.9% of the patients. The accessory port was
required in 8.5% of patients to complete the appendicectomy and
the conversion rate to open was 4.6%. The mean operation time
was 25 minutes and the mean hospital stay was 1.5 days. The port
site infection was seen in 14, bleeding in 20, parietal wall abscess in
three cases and intra-abdominal abscesses in 4 patients.
Conclusion: This approach is simple, can be converted to
total intracorporeal by inserting accessory port or to open
appendicectomy when required and has advantage of full
laparoscopy of abdomen. It has its limitations in cases of extreme
obesity, thick mesentery, gangrenous appendix, very large and
thick appendix, and difficulty in finding the appendix, control of
bleeding, division of adhesions and to deal with other associated
pathology. Cost was minimized by using non-disposable port. The
overall morbidity was low. There were no specific complications
related to this technique and incidence of port site infection was
similar to other approaches of laparoscopic appendicectomy
