Appendectomy spending more time then conventional appendectomy .the longer

Appendectomy is the most common surgical undertaking
in teens.Appendicitis is a clinical diagnosis & should be suspected in all
cases of lower Quadrant abdominal become more pertinent in obese due to
paucity of clinical features.
Although more than two decades have elapced since the advent of first
laproscopic Appendectomy which was performed by semm (in 1983 ) ,it is not
accepted as standard.Many surgeons considered laproscopic Appendectomy as a
precise procedure in doubtful cases or in females of reproductive age
group.literature revealed sufficient evidenc that laproscopic approach leads to
faster recovery of patient with few wound sequele.however these findings have
been opposed by other researchers who found no significant difference in
outcome of patient with open or laproscopic approach rather proven costly.
Recently ,many randomised controlled trails concluded that appendectomy can be
performed safely either through open or laproscopic approach.
obesity is a prevalent in west & now rapidly affecting our population affects many undergoing appendectomy in our social setups.a popular myth
that laproscopic appendectomy should be gold standard in obese stands on the
presumption that the increased wall thickness is a technical challenge during
open appendectomy limiting accurate hand movements & visibiltiy.more
dissection required in obese which ends up in prolong recovery time.recently
published data support.the present study also focused on the comparison of
laproscopic with open approach in appendicitis in obese.
most patients in our series were having BMI more than 30 with female
preponderance in age group of 20-30 years.surgical time is considered as
important predictors of procedural outcome.Most studies mentioned lon surgery
time with laproscopic approach.the likely explanation of this finding may be
learning curve of surgeons spending more time then conventional appendectomy
.the longer operation time in laproscopic appendectomy may be due to additional
steps like setup of instruments ,insufflations , ports positioning and a phase
of diagnostic contrast impact of learning curve was nill in our
series as procedure was performed by senior laproscopic surgeons.
Clarke etal  reported a markedly elevated
value for laproscopic group.our observations are different to a previously
published meta-analysis by Marker etal who investigated surgical time leased on
available data & detected  no
significant statistical difference between laproscopic & open appendectomy
group in normal  patients.but in
ourseries in obese , a significant reduction in operative time was
the short hosoital stay is not clinically relevant but it has impact on bed
occupancy &  poses a financial
burden.Nonetheless restoration of normal activities cannot be attributed to
short hospital stay only, because this vary from person to person attitude and
job nature.
Masoomi etal emphasized the advantage of laproscopic appendectomy by reporting
a low rate intraabdominal abcess formation in LA group.we also observed low
percentage of residual abcess formation in LA GROUP.These findings are
confronted by other studies that reported more abcess formation in LA group
than open appendectomy group.several hypothesis have been postulated to find
possible justification.
Mechanical spread of bacteria in peritoneal cavity by CO2 insufflations
especially in perforated appendicitis.inadequate learning curve extensive wash
instead of mopping or suction leading to soiling of peritoneal cavity.
Wound sepsis was observed more in open appendectomy group.wound complications
were encountered more in perforated appendicitis despite receiving prophylactic
& postop doses of antibiotics.second justification may be retrieved of
appendix  in endobag in LA.According to
masonetal main advantage of laproscopic surgery in obese patients with
appendicitis is reduced wound sepsis.
Postoperative pain intensity was managed by lesser doses of analgesia in LA
group.this effect is same in laproscopic surgery performed in obese as well as
in normal BMI Patients but has significantly reduced P<0.001.Analgesia dose in comparison to open appendectomy group. postoperative ileus was prolonged in OA group but this fact was statistically insignificant.longer duration may be reffered to more handling.mainly advantage of 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 a safe procedure as revealed by many studies.