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Year : 2022  |  Volume : 28  |  Issue : 1  |  Page : 29-31

Laparoscopic submucosal appendectomy for complicated appendicitis: A salvage technique to minimise complications

Department of Surgery, Koyili Hospital, Kannur, Kerala, India

Correspondence Address:
Dr. Jimmy C John
Department of Surgery, Koyili Hospital, Pallikunnu Post, Kannur - 670 002, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ksj.ksj_16_22

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Background: Complicated appendicitis with delayed presentations is difficult to manage surgically due to dense adhesions and distorted anatomy. Submucosal appendectomy could be an option in these cases. Materials and Methods: Out of 789 laparoscopic appendectomies, 239 were complicated cases. In 79 of these cases, no plane could be established between the appendix and adjacent bowel. Hence, the mucosa was identified by blunt dissection through the wall of intact appendix or through the perforation site and the mucosal tube was pulled out, and then dissected out fully from the tip and up to the base by blunt dissection, leaving behind the muscular wall. The base was then ligated and divided distally. Post-operatively, the patients were managed with ERAS protocol. Results: Out of 79 cases, 56 were male. Age ranged from 14 to 55 years. Forty-six cases were perforated, and 33 had mass formation. Submucosal appendectomy was done in all. There were no intra-operative complications. The average operating time was 56 min. In 68 cases, oral feeds were tolerated early, 11 cases suffered from prolonged ileus and one case had post-operative faecal leak, which settled on conservative management for 10 days. The average post-operative hospital stay was 3–5 days. Follow-up ranged from 2 months to 2 years. Three cases required re-admission, reported occasional abdominal pain, which on clinical evaluation and imaging showed no residual collection or stump appendicitis. Two cases presented with residual abscesses, which were managed with image-guided tube drainage. Conclusions: Submucosal appendectomy minimises bowel injury, avoids the need for conversion, and is a safe option for difficult cases during laparoscopy and also an alternative for the Ochsner–Sherren regimen.

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