THE EXPERIENCE OF TRANS UMBILICAL CONVENTIONAL APPENDICECTOMIES

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Abstract

Background: Acute appendicitis is the most common aetiology of the acute abdomen, generally requiring urgent
surgical intervention. The lifetime incidence of acute appendicitis is approximate 7%.
Objective: The aim of this study was to evaluate the safety, feasibility, and cosmetic result of a novel approach i.e.
conventional appendectomy via the trans umbilical route using routine open surgery instruments.
Material and Methods: This prospective study was conducted in Surgical unit Hayatabad Medical Complex Peshawar,
included 62 selected cases during period from Jan 2009 to Jan 2010 after taking permission from local ethical
and research committee. Inclusion criteria were a thin built patient with acute classical presentation in early stage of
appendicitis, cases posted for interval appendicectomies and recurrent attacks of appendicitis. Excluded from study
group were those patients who presented with complications of mass formation /abscess, undiagnosed obscure causes
of RIF pain with no classic history or findings and patients with pelvic peritonitis, pregnant patients and with history of
cirrhosis or coagulation alterations.
Results: The ages of the patients were 13–56 years (mean age, 32.7 ± 15.4 years). Conventional appendicectomy
was safely performed in 56 (90.3%) out of 62 cases, through single incision trans-umbilical route. In remaining 6 (9.7%)
cases an additional right iliac fossa incision with muscle cutting had to be employed for dissection of adhesions and
retrocaecal /sub-hepatic positions of inflamed appendix. The calculated conversion rate was about 9.6%. The mean
operative time was almost same compared to routine surgery by Mc Burney incision (27 min v/s 22 min). The average
hospital stay was 3 days. All patients werefollowed up for 3 months. Six cases reported with seroma and mild infection
from umbilicus which resolved spontaneously with conservative treatment. The estimated infection rate was 5.3 % in
our study. None of the patients had any incisional hernia postoperatively.
Conclusion: The transumbilical single-incision open approach with minimal invisible scar is seen as a feasible technique
for performing appendectomy in properly selected cases, does not increase the rate of complications and represents
a possible alternative to conventional appendicectomy through open right iliac fossa incision

Authors: 
Yousaf Jan
Rashid Islam
Waqas Waqas
Ihsan Ulhaq
Ahmad Din
Journal Issue: 

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