Outcome of mini appendectomy and laparoscopic appendectomy in acute appendicitis

Appendectomy remained standard treatment for acute appendicitis even after two centuries of chance appendectomy. Conventional appendectomy with standard Grid Iron incision in the era of minimally invasive surgery is loosening its essence. In low resource conditions when laparoscopic facilities are not available, mini appendectomy can be practiced as standard treatment to decrease morbidity of conventional appendectomy. Present study was conducted in Postgraduate Department of Surgery, Govt. Medical College; Jammu, over a period of 04 years from January 2013 to December 2016. 200 patients each were divided into two groups: Group I as mini appendectomy (MA), Group II as laparoscopic appendectomy (LA). Patients in Group I were operated under SA or GA. But all patients in Group II (LA) were operated under GA. Patients with clinically apparent appendicular lump, perforation peritonitis, marked obesity and doubtful diagnosis were not taken up for MA (Group I), but in Group II (LA) obese & patients with doubtful diagnosis were also considered. Our experience of mini appendectomy and laparoscopic appendectomy reveals that the two procedures are comparable in terms of analgesics use, hospital stay, return to routines and satisfaction with the scar, but laparoscopic appendectomy takes significantly more operating time than mini appendectomy. In low resource situations grid iron incision can be replaced with rectus muscle medial retracting mini appendectomy incision. However, patients with moderate to severe obesity and appendicular lump may not be fit for mini appendectomy. Furthermore, small incision of MA can be used as one of the ports for diagnostic laparoscopy if appendix is normal.