الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 154 |  |  |
| | | from | 154 | | |
Abstract
Acute appendicitis is one of the most common causes of abdominal surgical emergencies. Surgical appendectomy either open or laparoscopic remains the treatment of choice. Since the introduction of the laparoscopic appendectomy, it has become an alternative method of treatment to open appendectomy This study was conducted at Mansoura University Hospitals aiming to compare the effectiveness and safety of open versus laparoscopic appendectomy in the management of acute perforated appendicitis regarding operative time, postoperative pain, postoperative hospital stay and postoperative complications. Patients and methods: We included a total of 40 cases who were randomly divided into two groups; the first group included 20 cases who underwent the open approach (lower midline incision), whereas the other group included the remaining 20 cases who underwent the laparoscopic approach (3 port technique). All cases were subjected to complete history taking, thorough physical examination, and routine pre-operative laboratory investigations. Moreover, abdominal ultrasonography was performed for all cases and CT if the U/S is unsatisfactory. Results: The majority of cases were middle aged. Males represented (50%) of cases in open group and (40%) in laparoscopic groups, whereas the remaining cases were females. Hypertension was the commonest comorbidity, followed by diabetes and ischemic heart .Cesarean section was the commonest previous abdominal operation, followed by cholecystectomy and splenectomy High grade fever was present in almost all cases with Diffuse abdominal tenderness .Leucocytic count had median of (18.4) in the open group and (19.2) in the laparoscopic group. Operative time was markedly reduced in the laparoscopic group (45 vs. 60 minutes). Oral intake was regained significantly earlier in the laparoscopic group .Post-operative pain was markedly reduced in the laparoscopic group (VAS 3 vs. 5 in the open group). Moreover, the duration of hospital stay was markedly reduced in the same group (2 vs. 4 days). The incidence of surgical site infection was significantly higher in the open group (25 vs. 5% of cases in the laparoscopic group). Abdominal drain was removed on the 4th and 2nd post-operative days in both groups respectively. Appendicular stump leakage was encountered in only one case in the open group drainage. There was statistically significant difference between both groups in terms of (operative time, postoperative pain, wound infection, time to start oral feeding, postoperative hospital stay and time to return to normal activity). Laparoscopic approach with superior to open approach in all these items. Conclusion: Laparoscopic appendectomy is safe and feasible technique in management of acute perforated appendicitis with comparable complications rate. Laparoscopy is superior in the reduction of wound infection, postoperative pain, postoperative hospital stay with shorter operative time. Also early start oral feeding and return to normal activities.