Discussion and compared the open and laparoscopic techniques

Discussion

Acute appendicitis is the commonest cause of Acute abdomen in teens requiring emergency intervention 8. The possibility of appendicitis must be considered in any patient presenting with lower abdominal pain and such diagnosis is still a challenge in obese patients 9, 10. Although more than 20 years have elapsed since the introduction of laparoscopic appendectomy (performed in 1983 by Semm, a gynecologist), open appendectomy is still the widely practiced procedure. Some authors consider emergency laparoscopy as a precise tool for the treatment of abdominal emergencies like appendicitis especially in females of reproductive age groups  11, 12. Several studies 13, 14, 15 reflect that laparoscopic appendectomy is associated with faster restoration of normal activities with fewer wound Sequele. These findings have been contradicted by many researchers who showed no significant difference in the outcome between the two procedures, and more expenses with laparoscopic appendectomy.  Recent meta-analyses of randomized controlled trials comparing laparoscopic versus conventional appendectomy depicted that acute appendicitis can be dealt with with open and laparoscopic approach safely 16,17.

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 Obesity is a prevalent medical condition in western societies and also affects a great percentage of common people undergoing appendectomy in our social setups. A popular myth that laparoscopic appendectomy should be “Gold Standard” in obese patients stands on the presumption that the increased abdominal wall thickness is a technical challenge during open appendectomy limiting accurate hand movements and visibility. More dissection required which ends up with prolong recovery time. Recently, published papers have considered laparoscopic approach as a better option in obese. Our study  focused on the obese  patients and compared the open and laparoscopic techniques for appendectomy. Most of the patients in our series were having BMI more than 30 with a female preponderance in the age group of 20-30 years.

 Surgical time is considered as important predictor of the procedural outcome. Most studies mentioned a long surgery time with laparoscopic approach .The likely explanation of this finding may be learning curve of the surgeons spending more time than conventional appendectomy. The longer operation time in laparoscopic appendectomy may be due to additional steps like setup of instruments, insufflations, making ports under vision and a phase of diagnostic laparoscopy. By contrast, in our series the impact of learning curve was almost nil as all surgeons performed the procedure were senior consultants..  Clarke et al.,6 reported a markedly elevated value for the laparoscopic appendectomy group. Our observations are different to a previously published meta-analysis by Markar et al.18  who investigated surgical time based on data available in3,19and detected no significant difference between laparoscopic and open appendectomy in normal patients. But in our series in obese patients, this finding is different20  which demonstrated a significant decrease of surgical time in the laparoscopic appendectomy group (P 

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