Alarfaj Haytham, Bu Bshait Mohammed S
Department of Surgery, College of Medicine, King Faisal University, Al Ahsa, SAU.
Cureus. 2024 Nov 16;16(11):e73791. doi: 10.7759/cureus.73791. eCollection 2024 Nov.
Introduction Laparoscopic appendectomy is currently considered the operation of choice for patients with suspected acute appendicitis. This study aimed to assess the safety and feasibility of laparoscopic appendectomy in the setting of a secondary referral hospital. Methods A retrospective cohort study was conducted from January 2021 to December 2023. Records of patients older than 14 years of age who underwent appendectomy were retrieved. Patients were divided according to the type of technique used into two groups: group I (G1) consisted of patients who underwent laparoscopic appendectomy and group II (G2) included those with an open appendectomy. Patients who underwent interval appendectomy or incidental to other procedures were excluded. The two groups were compared in terms of patient demographics, pathological findings, operative time, postoperative course, and outcome. Results Laparoscopic appendectomy was performed in 101 patients while open appendectomy was done in 121 patients. There were no statistical differences between both groups regarding operative time, blood loss, time for oral intake resumption, hospital stay, or postoperative complications. Despite being not statistically significant, surgical site infection was lower in G1 as compared to G2 (3% versus 8.3%, p=0.09). Narcotic use was significantly less following laparoscopic appendectomy. In the late settings cases of G1, there was a relatively improved mean operative time (32.7 ±18.3) when compared to early settings appendectomy (62.4±26.3), which was statistically significant (=0.001). Conclusion Laparoscopic appendectomy is safe, feasible, and adoptable even by junior staff. Therefore, it could be applicable in settings of secondary referral hospitals as an initial line of management when performed by an expert surgeon or trainee under the supervision of seniors.
引言 腹腔镜阑尾切除术目前被认为是疑似急性阑尾炎患者的首选手术方式。本研究旨在评估在二级转诊医院进行腹腔镜阑尾切除术的安全性和可行性。方法 进行了一项回顾性队列研究,时间跨度为2021年1月至2023年12月。检索了年龄大于14岁且接受阑尾切除术患者的记录。根据所采用的技术类型将患者分为两组:第一组(G1)为接受腹腔镜阑尾切除术的患者,第二组(G2)包括接受开腹阑尾切除术的患者。排除接受间隔期阑尾切除术或作为其他手术附带操作的患者。比较两组患者的人口统计学特征、病理结果、手术时间、术后病程和结局。结果 101例患者接受了腹腔镜阑尾切除术,121例患者接受了开腹阑尾切除术。两组在手术时间、失血量、恢复经口进食时间、住院时间或术后并发症方面无统计学差异。尽管差异无统计学意义,但G1组的手术部位感染率低于G2组(3%对8.3%,p=0.09)。腹腔镜阑尾切除术后的麻醉药物使用明显较少。在G1组的晚期病例中,与早期病例的阑尾切除术相比,平均手术时间相对缩短(32.7±18.3),差异有统计学意义(p=0.001)。结论 腹腔镜阑尾切除术是安全、可行的,甚至初级医务人员也可采用。因此,当由专家外科医生或在上级监督下的实习生进行时,它可作为二级转诊医院初始治疗方案应用。