Appendectomy of reproductive age group.literature revealed sufficient evidenc

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Last updated: June 6, 2019

Appendectomy is the most common surgical undertakingin teens.Appendicitis is a clinical diagnosis & should be suspected in allcases of lower Quadrant abdominal pain.it become more pertinent in obese due topaucity of clinical features.Although more than two decades have elapced since the advent of firstlaproscopic Appendectomy which was performed by semm (in 1983 ) ,it is notaccepted as standard.Many surgeons considered laproscopic Appendectomy as aprecise procedure in doubtful cases or in females of reproductive agegroup.literature revealed sufficient evidenc that laproscopic approach leads tofaster recovery of patient with few wound sequele.however these findings havebeen opposed by other researchers who found no significant difference inoutcome of patient with open or laproscopic approach rather proven costly.Recently ,many randomised controlled trails concluded that appendectomy can beperformed safely either through open or laproscopic approach.obesity is a prevalent in west & now rapidly affecting our populationtoo.it affects many undergoing appendectomy in our social setups.a popular myththat laproscopic appendectomy should be gold standard in obese stands on thepresumption that the increased wall thickness is a technical challenge duringopen appendectomy limiting accurate hand movements & visibiltiy.moredissection required in obese which ends up in prolong recovery time.recentlypublished data support.the present study also focused on the comparison oflaproscopic with open approach in appendicitis in obese.most patients in our series were having BMI more than 30 with femalepreponderance in age group of 20-30 years.surgical time is considered asimportant predictors of procedural outcome.Most studies mentioned lon surgerytime with laproscopic approach.the likely explanation of this finding may belearning curve of surgeons spending more time then conventional appendectomy.the longer operation time in laproscopic appendectomy may be due to additionalsteps like setup of instruments ,insufflations , ports positioning and a phaseof diagnostic laproscopy.by contrast impact of learning curve was nill in ourseries as procedure was performed by senior laproscopic surgeons.Clarke etal  reported a markedly elevatedvalue for laproscopic group.our observations are different to a previouslypublished meta-analysis by Marker etal who investigated surgical time leased onavailable data & detected  nosignificant statistical difference between laproscopic & open appendectomygroup in normal  patients.but inourseries in obese , a significant reduction in operative time wasdetected.(0.001).the short hosoital stay is not clinically relevant but it has impact on bedoccupancy &  poses a financialburden.Nonetheless restoration of normal activities cannot be attributed toshort hospital stay only, because this vary from person to person attitude andjob nature.Masoomi etal emphasized the advantage of laproscopic appendectomy by reportinga low rate intraabdominal abcess formation in LA group.we also observed lowpercentage of residual abcess formation in LA GROUP.These findings areconfronted by other studies that reported more abcess formation in LA groupthan open appendectomy group.several hypothesis have been postulated to findpossible justification.Mechanical spread of bacteria in peritoneal cavity by CO2 insufflationsespecially in perforated appendicitis.inadequate learning curve extensive washinstead of mopping or suction leading to soiling of peritoneal cavity.Wound sepsis was observed more in open appendectomy group.wound complicationswere encountered more in perforated appendicitis despite receiving prophylactic& postop doses of antibiotics.second justification may be retrieved ofappendix  in endobag in LA.According tomasonetal main advantage of laproscopic surgery in obese patients withappendicitis is reduced wound sepsis.Postoperative pain intensity was managed by lesser doses of analgesia in LAgroup.this effect is same in laproscopic surgery performed in obese as well asin normal BMI Patients but has significantly reduced P<0.001.Analgesia dosein comparison to open appendectomy group.postoperative ileus was prolonged in OA group but this fact was statisticallyinsignificant.longer duration may be reffered to more handling.mainly advantageof less ileus is either to laproscopic approach or due to less use of analgesi.the mortality rate wa negligible in our series.In general appendectomy performed either through laproscopic or open route is asafe procedure as revealed by many studies.

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