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In the name of god

Comparison of laparoscopic Vs. open appendectomy for acute non perforated and perforated appendicitis in the obese population presented by:rezaeisadrabadi M. In the name of god. introduction. After endoscopy Semm introduced Laparoscopic Appendectomy(LA) in 1983

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In the name of god

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  1. Comparison of laparoscopic Vs. open appendectomy for acute non perforated and perforated appendicitis in the obese populationpresented by:rezaeisadrabadi M. In the name of god

  2. introduction • After endoscopy Semm introduced Laparoscopic Appendectomy(LA) in 1983 • The use of it increased by in the management of acute appendicitis remains controversial • A recent meta-analysis reviewed 67 RCT showed that LA is better than open appendectomy in decreasing wound infection, but increased costs, prolonged surgical time and a higher rate of intra abdominal infection

  3. Introduction(continued) • Return to normal activity, work and sport was earlier in LA • So, LA recommended in patients with suspected appendicitis, specially young female, obese and employed patients • There have been few studies which compared LA Vs. OA in obese population and they have shown that complications like wound infection, postoperative pain, length of hospital stay decreased in LA

  4. Introduction(continued) • Although LA is recommended for in obese patients, OA remains the most common procedure performed for acute perforated appendicitis • To date, there have been no studies comparing outcomes of LA and OA in obese patients with either perforated or non perforated appendicitis

  5. objectives • 1.evaluate the use of LA in the obese patient population who underwent appendectomy for acute appendicitis in the united states • 2.compare the outcomes of LA Vs. OA in nonperforated and perforated appendicitis in obese patients by 4 components: • Postoperative complications • Length of hospital stay(LOS) • In-hospital mortality • Total hospital charges

  6. methods • Using Nationwide Inpatient Sample(NIS) • NIS data are collected from hospital discharge abstracts that allow determination of all procedures performed during admission • variables including patient characteristics, LOS, specific post operative morbidity and in-hospital mortality • NIS database holds no information on complications arising after discharge

  7. Data analysis • Discharge data of obese and morbidly obese patients who underwent appendectomy for suspected acute appendicitis from 2006 to 2008 • Although we did not have data about BMI of patients • Exclusion criteria: • Incidental appendectomy • Elective appendectomy • Nonsurgical treated appendicitis

  8. results • 42426 obese patients underwent urgent appendectomy which accounted for 5.0 % of all appendectomies • Mean age= 40.6 • 52.7% female • 66.5% Caucasian

  9. results(continued) • Perforated appendicitis was higher in obese patients (32.7% Vs. 25.2% ; p< 0.01) • rate of LA in obese patients was slightly higher (62.05% Vs. 61.57% ; p= 0.047) • 28546 obese patients who 19554 underwent LA (68.5) and 8992 underwent OA (31.5%) • The average age was 38 years in both groups and most of patients were Caucasian • Overall complication rate was lower in LA group compared with OA(7.17% Vs. 11.72% ;p, 0.01)

  10. Most of the post operative complications were higher for the OA group Except DVT which was higher for the LA group • In-hospital mortality rate was lower in LA (0.09% Vs. 23 % ; p,0.01LOS and Total hospital charges were lower in LA Group

  11. Perforated appendicitis • 13879patients that 7110 underwent LA (51.2%) and 6769 underwent OA(48.8%) • Unlike with nonperforated appendicitis, the LA group had a lower mean age(43.8 y Vs. 46.5 y; p,0.01) • Similar to nonperforated in-hospital complication rate was lower in the LA group • All the complications were significantly lower in the LA except UTI and MI which were similar between groups • Mortality total charges and LOS was lower in LA

  12. Risk-adjusted outcomes • After adjusting for variables (age, sex, co morbidity, race, type of appendicitis) LA still was associated with a lower mortality rate(OR,0.22;95%CI) and a lower complication rate (OR,0.59;95CI) • In addition all the complications were lower for the LA except for MI ,for which there was no effect of type of procedures

  13. conclusion • Compared with OA,LA is associated with a lower complication rate, lower mortality rate, shorter LOS, and lower total hospital charges in both perforated and nonperforated appendicitis in the obese population

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