OPEN APPENDISECTOMY

• MODUL :

• IDA BAGUS ANANTA WIJAYA

Anatomy of Appendix
Mesoappendiks + appendicular arteri
Etiologi apendisitis akut
• Penyebab pasti masih diperdebatkan.
• Faktor obstruksi:
• Hiperplasia jaringan limfoid.
• Stasis fekal atau fekalit.
• Corpus alienum.
• Neoplasma.
• Faktor infeksi: virus & bakteri.
• Faktor diet: konstipasi
Fekalit/apendikolit
Infeksi bakteri
Bakteri anaerob Persentase pasien

Bacteroides fragilis 80

Bacteroides thetaiotaomicron 61

Bilophila wadsworthia 55

Peptostreptococcus species 46

Bakteri aerob Persentase pasien

Escherichia coli 77
Streptococcus viridans 43
Group D streptococcus 27
Pseudomonas aeruginosa 18
Patofisiologi apendisitis akut
Clinical
Diagnosis History
Signs & Simptoms
Laboratory findings
Clinical scoring system
Imaging studies
 Physical Examination

Inspection Auscultation Palpation Percussion RT

Pointing sign
Rovsing’s sign
Psoas sign
Obturator sign
USG Appendiks
Ct-scan potongan melintang
 Preoperative investigation in appendicitis

• Routine
• Full blood count
• Urinalysis
• Selective
• Pregnancy test
• Urea and electrolites
• Supine abdominal radiograph
• Ultrasound of the abdominal / pelvic
• Contrast-enchanced abdominal and pelvic CT scan
TREATMENT

Surgical
treatment for
acute appendicitis

Open Laparoscopic
Appendectomy Appendectomy
(OA) (LA)
Open appendisectomy
Post Operative Complications

• Wound Infection
• Intra-abdominal abscess
• Ileus
• Respiratory
• Venous trombosis and embolism
• Portal pyaemia (pylephlebitis)
• Faecal fistula
• Adhesive intestinal obstruction
Background

Surgical
treatment for
acute appendicitis

Open Laparoscopic
Appendectomy Appendectomy
(OA) (LA)
Patients and Methods

• Th is was a Retrospective study conducted in the department of General

Surgery, Liaquat National Hospital, Karachi, Pakistan for 1 year between
Jan 2015-Dec 2015.

• Patients were assessed for acute appendicitis and were divided into two
groups based on open and laparoscopic appendectomies.

• Patient’s clinical files and records were retrieved and assessed and data
was entered into a study proforma and analyzed using SPSS soft ware.
 Results
• 156 patients 108 male (69%) and 48 female (31%)
• There were 90 laparoscopic and 66 open procedures.
• Of the total 90 cases in laparoscopic appendectomies 11 (12.2%) had
superficial surgical site infection (SSSI), while in the open group 10 (15.1%)
developed superficial surgical site infection.
• The comparative analysis showing p-value was of 0.48 which was statistically
insignificant.
• A total of 2 (2.2%) patients in the laparoscopic group developed organ space
infection and were managed by pig tail drainage showed p-value of <0.05
which was statistically significant. In the open group no patients developed
organ space infection.
 Conclusion
Laparoscopic appendectomy is not associated with lower surgical site
infections ascompared to open appendectomy but the severity of disease is
the factor for increased organ space infection.
TERIMA KASIH