LAPAROSCOPIC APPENDICECTOMY Experience with initial 60 cases Dr. J.T. Sankpal Dr. R.D. Kamble Dr. S.N Deshmukh Dr. A.N. Maske Dr. N.V. Rayte

Epidemiological Profile Total 60 cases were studied 38 were males 22 were females Youngest was 8 year child Oldest was 60 year male

Diagnosis : Investigations 1) Routine -. Hb, CBC Diagnosis : Investigations 1) Routine - Hb, CBC Urine 2) X-ray standing abdomen 3) USG Abdomen

Anaesthesia : General Anaesthesia with Ryle’s tube and Foley’s Catheter in Situ Spinal Anaesthesia can be used.

Port position

Port position

Method Used to Ligate The Base Endoloop-22 Intracarporal knot-21 Extracarporal knot-17

Retrieval of specimen

Type of Appendicitis Acute -35 Chronic recurrent - 25

Operative Time Average operative time for initial 20 cases was (96 mins) i.e.1 hour and 36 mins. Average operative time for next 40 cases was 33 mins.

Grading of appendicitis Depending on intra operative findings appendicitis was graded into 3 grades Grade I- Mild = minimal adhesions,free fluid 18cases Grade II- Moderate = dilated bowel coils 22 cases Grade III- Severe = Perforated appendix, gangrene, dense adhesions 20 cases Drain was kept in 4 cases

Conversion to Open Conversion Rate First 20 3 Last 40 1(Intra-operatively a rent is seen which was considered to be ilial perforation but on opening it was a rent in mesentery)

In which patients it is contraindicated 1) Bleeding disorders 2) History of lower abdominal surgery 3) Portal hypertension

Discussion As a diagnostic and therapeutic tool Other abdominal pathologies identified can be treated; like ovarian cyst, gallstone.

Complications : Nil For example : Port site infection Complications : Nil For example : Port site infection. Prolonged ileus Portal pyemia Faecal fistula Adhesive intestinal obstruction. Port site hernia.

CONCLUSION Minimally Invasive Less Tissue Dissection Less requirement of analgesics and IV fluids. Early return to oral diet Less hospital stay (Avg.2 days) Cosmetically better outcome Negative appendicectomies avoided

References : Borgestein P J , Gordjin - Prospective study on role of laparoscopy, surgery endoscopic 1997. Fitzgibbin R J, Hinder - Indication for lap - appendicectomy surg. Endoscopic , 1994. Frazee R C, Roberts, Prospective randomised trial of open vs. lap appendecectomy , Ann. Surg. 1994. Miller J P , Lap. Appendcectomy , Paeditric Ann, 1993. Slim, Lap on open appendecectomy , Dis colon rectum 1998 Vargus , Averbrooke , Appendix mass conservative therapy followed by lap appendicectomy , Ann. Surg. 94. Nyhaus surgery, 4th edition. The art of laparoscopic surgery. Pallanivellu

For too much of zeal for what is new, one should not make cure of disease more grievous than the disease itself , laparoscopic surgeon should ask himself - Well established indication. - Proper selection of patient. - Adequate experience of open surgery. - Don’t go beyond point of No return.

THANK YOU