Laparoscopic Appendectomy in a Nigerian Teaching Hospital

摘要

Objective: Laparoscopic appendectomy in a setting where resources are poor is still controversial. This study evaluates the impact of laparoscopy on the early outcome of acute appendicitis in a developing country. Methods: All patients who underwent appendectomy from January 2010 through June 2011 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria were recruited for this study. Results: Of the 139 patients with acute appendicitis within the study period, 83 (59.7%) had open appendectomy (OA), 19 (13.7%) whose clinical and radiological findings suggested complicated appendicitis at presentation had laparotomy, while 37 (26.6%) had laparoscopic procedures. In the laparoscopy group, initial diagnostic laparoscopy in 4 (10.8%) patients revealed a normal appendix along with other findings that precluded appendectomy. Laparoscopic appendectomy (LA) was then performed in 33 (23.7%) patients with 2 of these (6.1%) requiring conversion to open laparotomy. Mean time for the LA procedure was higher than that observed for OA (56.2 vs 38.9 min). Patients in the LA group had a shorter mean postoperative stay (1.8 vs 3.0). Wound infection occurred in 2 (6.5%) patients from the LA group and 8 (9.6%) from OA. Conclusion: Laparoscopic appendectomy reduced the rate of unnecessary appendectomy and postoperative hospital stay in our patients, potentially reducing crowding in our surgical wards. We advocate increased use of laparoscopy especially in young women.