complications during and after laparoscopic appendectomy

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patients treated by the laparoscopic method (intestinal lesions and bleeding from mesoappendix) which were handled during surgery, did not lead to conversion into an open procedure and had no impact on postoperative recovery. Trocar injuries represent a significant complication of laparoscopic surgery resulting in the most serious injuries, such as vascular injuries. The most common intraoperative complication of laparoscopic appendectomy was bleeding from the mesoappendix 4,14 . There are different under-lying causes of an unsuccessful procedure – the most frequently stated reasons include the position of the appendix, adhesions, obesity, bleeding and abscess 10,15 . Most of the reasons for conversions occur due to the insufficient experience of the surgeons. Of course they are very rare in cases of experienced surgeons. The learning curve of laparoscopic appendectomy gives five appendectomy, when the number of intraoperative and postoperative complications is reduced, and this operation can be recommended as a model for learning in laparoscopic surgery. Laparoscopy is characterized by decreased traumatization of tissue and lesser irritation of intestines, less severe postoperative pain and shorter stays in hospitals as well as faster recovery and return to normal activities, which is of special importance for patients who are supposed to return to work 11,12 . Five-millimeter trocars do not require the closure of the parietal wall, resulting in less postoperative pain and a smaller scar. As stated by other studies, the lower rate of infections of surgical wounds may be explained by the extraction of the inflamed appendix in an endobag, while in the group of patients treated by the classical method the healing of wounds was delayed in 25%. Delayed healing of wounds in combination with longer hospitalization and treatment with antibiotics significantly increases the cost of treatment 13,16 . Intra-abdominal abscess occurred in LA in only one case of uncomplicated appendicitis. It was treated with ultrasound guided drainage, the method that should have preference in the treatment of such kinds of complications. In open appendectomy intra-abdominal abscess occurs in 2 to 3% of cases. Most studies have noted a slightly higher incidence of abscess in laparoscopic appendectomy. Inappropriate techniques, which certainly include, for example, squeezing of the appendix during appendectomy, instead of seizing the mesentery, and inadequate toilet of the peritoneal cavity, result in a slightly higher incidence 9,17 . However, there is an increasing number of reports stating that there is no difference in the creation of an abscess in classical and laparoscopic appendectomy. This will certainly be achieved by improved experience of surgeons and better toilet of the intraperitoneal space6. In cases of perforated appendicitis there is an increased incidence of the creation of abscess, regardless of the kind of technique used. A limitation of this study is the size of the sample, but its results are consistent with other published studies. This study confirms previously conducted studies and demonstrates that in patients treated by the laparoscopic method the risk of wound infection is smaller; intraoperative complications, which do not affect the postoperative period, decrease with the number of surgeries performed. Acknowledgment: I thank the Department of Surgery of the University Clinical Centre, Tuzla, and my mentor, Prof. Delibegović for his assistance in undertaking this study. Received: 12 November 2011/Accepted: 14 May 2012 REFERENCES 1. Cueto J, D’Alemagne B, Va´ zquez-Frias J.A, Gonza R, Mansur H, Gomez S, et al. Morbidity of laparoscopic surgery for complicated appendicitis: an international study. Surg Endosc. 2006;20:717-720. 52
2. Semm K. Endoscopic appendectomy. Endoscopy. 1983;15:59-64. 3. Delibegović S, Matović. E Hem-o-lok plastic clips in securing of the base of the appendix during laparoscopic appendectomy. Surg Endosc. 2009;23:2851- 2854. 4. Hansen JB, Smithers BM, Schache D, Wal D, Miller BJ, Menzies JL. Laparoscopic versus open appendectomy: prospective randomized trial. World J Surg. 1996;20:17-21. 5. Guller U, Nitin J, Eric P, Lawrence M, Steve E, Ricardo P. Laparoscopic appendectomy in the elderly. Surgery. 2004;12: 479. 6. Koluh A, Delibegović S, Hasukić Š, Valjan V, Latić F. Laparoscopic apendectomy in the treatment of acute apendicitis. Medical Archives. 2010;64:78-83. 7. Namir K, Rodney J, Shirin T, Anna G, Rahila E. Laparoscopic versus open appen-dectomy. Surgery. 2005;135:439-450. 8. Ortega AE, Hunter JG, Peters JH, Swanstrom LL, Schirmer B. A prospective randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic Appendectomy Study Group. Am J Surg. 1995;169:208-213. 9. Pedersen AG, Petersen OB, Wara P, Ronning H, Quist N, Laurberg S. Randomized clinical trial of laparoscopic versus open apendicectomy. B J Surg. 2001;88:200-205. 10. Mutter D, Vix M, Bui A, Evrard S, Tassetti V, Breton JF, et al. Laparoscopy not recommended for appendectomy in men: Results of a prospective randomized study routine. Surgery. 1996;70-74. 11. Kouwenhoven EA, Repelaer van Driel OJ, Erp WF. Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic. Surg Endosc. 2005; 19: 923-926. 12. McAnena OJ, Austin O, O’Connell PR, Hederman WP, Gorey TF, Fitzpatrick J. Laparoscopic versus open appendicectomy: a prospective evaluation. Br J Surg. 1992; 79:818-820. 13. Shabtai M, Rosin D, Zmora O, Munz Y, Scarlat A, Shabtai E, et al. The impact of a resident’s seniority on operative time and length of hospital stay for laparoscopic appendectomy. Outcomes used to measure the resident’s laparoscopic skills. Surg Endosc. 2004;18:1328-1330. 14. Pier A, Gotz F, Bacher C. Laparoscopic appendectomy in 625 cases: from innovation to routine. Surg Laparosc Endosc. 1991;1:8-13. 15. Schreiber JH. Early experience with laparoscopic appendectomy in women. Surg Endosc. 1987;1:211- 216. 16. Ludvig KA, Cattey RP, Henry LG. Initial experience with laparoscopic appendectomy. Dis Colon Rectum. 1993;36:463-467. 17. Liang MK, Helen GL, Marks JL. Stump Appendicitis: a comprehensive review of literature. The American Surgeon. 2006;72:162-166. 53
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