1. 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

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

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

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

8. Port position

9. Port position

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

19. Retrieval of specimen

21. Type of Appendicitis
Acute -35
Chronic recurrent - 25

22. 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.

23. 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

24. 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)

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

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

27. 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.

28. 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

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

30. 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.

31. THANK YOU