Laparoscopic assisted two port open appendicectomy

The laparoscopic appendicectomy can be performed using one to several ports. We present our experience of two port laparoscopic assisted open appendicectomy. The objective was to assess the results retrospectively in terms of complications and its limitations.

Between years 1998-2007, a two port laparoscopic assisted appendectomy was attempted in 2380 adult patients with suspected appendicitis. The patients with localized or generalized peritonitis were included. The appendicectomy was performed via an assisted two port method using 10 mm umbilical optical port and another 10 mm port in right iliac fossa. The children aged 12 and below and pregnant patients were excluded. All patients had their laparoscopic appendicectomy within 48 hours of admission.

Two port laparoscopic assisted appendicectomy was successful in 86.9% of cases. Acute appendicitis was the cause of acute abdomen in 88.9% of the patients. The accessory port was required in 8.5% of patients to complete the appendicectomy and the conversion rate to open was 4.6%. The mean operation time was 25 minutes and the mean hospital stay was 1.5 days. The port site infection was seen in 14, bleeding in 20, parietal wall abscess in three cases and intra-abdominal abscesses in 4 patients.

This approach is simple, can be converted to total intracorporeal by inserting accessory port or to open appendicectomy when required and has advantage of full laparoscopy of abdomen. It has its limitations in cases of extreme obesity, thick mesentery, gangrenous appendix, very large and thick appendix, and difficulty in finding the appendix, control of bleeding, division of adhesions and to deal with other associated pathology. Cost was minimized by using non-disposable port. The overall morbidity was low. There were no specific complications related to this technique and incidence of port site infection was similar to other approaches of laparoscopic appendicectomy.