Development of a Two Port Laparoscopic Appendectomy Technique at a Rural Hospital

Using the endoscopic snare to facilitate two-port laparoscopic appendectomy

BACKGROUND

Laparoscopic appendectomy is now the gold-standard treatment for acute appendicitis, requiring three ports for a classic procedure. Recent laparoscopy improvements aim to minimize surgical trauma and improve cosmetic quality through smaller, fewer portal incisions, such as two-port laparoscopic appendectomy, resulting in reduced postoperative pain. We aimed in this study to describe a novel technique to facilitate two-port laparoscopic appendectomy using the endoscopic snare.

PATIENTS AND METHODS

The data for a total of 85 patients, who underwent the two-port laparoscopic appendectomy using the endoscopic snare, at two research centers in Zagazig city, Egypt, from July 2022 till July 2023, is retrospectively analyzed. Overall length of hospital stay was the primary outcome, and the duration of operation and patient cosmetic satisfaction were secondary endpoints.

RESULTS

All the 85 laparoscopic procedures were completed without difficulty. The mean operative time was 43.78 ± 8.46 min (minimum: 34 min, maximum: 57 min). Length of hospitalization was 1.12 ± 0.74 days (min: 1 day, max: 2 days). No major complications were encountered. Four cases of minor postoperative complication occurred, in which the patient developed port site infection, which was completely resolved at one week postoperatively.

CONCLUSION

Laparoscopic appendectomy, using only two ports and endoscopic snare, is generally feasible and has been linked to high patient satisfaction and excellent cosmetic outcomes.

Appendiceal Diverticulitis in a Young Female Diagnosed on Pathology after Laparoscopic Appendectomy for Acute Appendicitis

Background. Appendiceal diverticulitis is a rare cause of inflammation of the appendix, which may mimic acute appendicitis. Its diagnosis is often delayed, and its occurrence carries an increased risk of significant complications, such as perforation. Case Presentation. A 23-year-old woman presented with sudden onset, severe, right lower quadrant abdominal pain and nausea. Her WBC was elevated, and abdominal CT showed findings indicative of acute appendicitis with a 13 mm fluid-filled appendix and local stranding. During laparoscopic appendectomy, significant inflammation was found around the appendix with some mucous material around the tip. The appendix base was not involved, and an endoloop was used to secure the stump. No other intra-abdominal abnormalities were observed. The patient recovered uneventfully. Pathology showed no classic appendicitis but appendiceal diverticulitis with signs of perforation. Discussion. Appendiceal diverticulitis is a rare condition which cannot be distinguished from acute appendicits clinically and on imaging. Diagnosis may be established based on pathology such as in our case. Appendectomy is indicated in appendiceal diverticulitis, and an appendix diverticulum is incidentally found during surgery or other investigations. This is due to the increased risk of perforation and the reported development of malignant tumors, including the appendix carcinoid.