الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute appendicitis is one of the most common causes of abdominal surgical emergencies with a life time prevalence of approximately one in seven worldwide (1). Surgical appendectomy either open or laparoscopicremains the treatment of choice (12). Since the introduction of the laparoscopic appendectomy, it has become an alternative method of treatment to open appendectomy, because it is better than open appendectomy in terms of postoperative wound infections, analgesia requirements, duration of hospital stay, interval before return to work and overall recovery(68).It also seems to have various advantages over open appendectomy in females and obese patients(29).With increasing prevalence of obesity all over the world (reaching to level of one third of people) and high percentage of wound complications in obese patients during open surgery, give great attention and increase concern about laparoscopy(27). In the embryonic period of laparoscopy, obesity was actually considered a contraindication for many operations including cholecystectomy. Despite these early concerns, the laparoscopic approach has since become the gold standard approach for abdominal surgery in patients with increased body mass index (BMI) (21).
The aim of the present study was to compare standard 3 ports laparoscopic appendectomy versus open appendectomy in obese patients in the terms of feasibility and difficulties of the technique, operative time,PO pain, PO hospital stay, PO complication (mostly wound complications) and patient satisfaction regarding cosmesis.
The study was carried on forty obese patients presented to the emergency department of the Alexandria Main University Hospital with acute appendicitis.Patients were randomized by closed envelope technique into 2 groups: group I who underwent compare standard 3 ports laparoscopic appendectomyand group II who underwent open appendectomy with classical grid iron incision at McBurney point. Patients with complicated appendicitis (appendicular mass or abcess), patients with previous lower abdominal surgery by midline and right para-median incision and patients with contraindication to laparoscopy were excluded from the study.
All patients were subjected to detailed history taking, physical examination and routine investigations. Abdominal ultrasonography was done to confirm the diagnosis and CT if the U/S is unsatisfactory.
The total operative time was higher in the laparoscopic group with a median of 70 min compared to 66 min in the open group. In laparoscopic group, we had 2 cases with gall bladder stones and 2 cases with ovarian cysts and were managed at same procedure.
In this study, another trocar was added in only 1 patient of the laparoscopic group which helped in traction of caecum in long subhepatic retrocecal appendix. In another patient, adherent omentum to previous PUC hernioplasty incision was found which obscured and narrowed the field