Online ISSN: 2515-8260

Keywords : acute appendicitis

Closure of Appendicular Stump in Laparoscopic Appendectomy by Ligation and Clipping Methods

Mohammed Gamal Youssef ; Samir Ibrahim Mohammed; Islam Mohamed Ibrahim, Mohammad Farouk Amin

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 466-476

Background: Laparoscopic appendectomy (LA) is now the standard of management
for cases of acute appendicitis. LA has the benefits of minimal access surgery.
There are many methods for securing the base of the appendix, some of which are
expensive others are not available or technically demanding. This study is aimed to
compare between ligation and clipping techniques regarding fesibility , safety ,
efficacy, operative time , postoperative outcome and complications. Patients and
methods: A randomized prospective clinical trial study included 90 patients with
acute appendicitis. The patients were randomly distributed into 2 main groups
(A&B): 54 patients we secured the base of the appendix by ligation methods (group
A) and in 36 patients by clip application (group B). All patients were subjected to
classic history taking and clinical examination. Radiological investigation:
ultrasonography was routinely done for all patients. CT with contrast was requested
when indicated in suspicion of complications. Surgical ligation or clipping were
performed. Results: There is statistically non-significant difference between
patients underwent different surgical techniques as regarding application of
peritoneal drainor conversion to open. Two patients within ligation group (A) had
been converted to open due to presence of friable base in one case and intraoperative
bleeding in other case while three patients within clipping group (B) had
been converted to open due to intestinal injury, friable base and intra-operative
bleeding .Two cases in clipping group (B) had been converted to ligation techniques
due to very wide base which can't be secured by clip application. Conclusion:
Ligation and clipping techniques were effective, safe ,feasible and same in
complications rate. Clip application is related to less operative time , easier
application and simpler for trainee than ligation techniques which require
more experiences.

Acute Appendicitis In Pregnancy: The Presentation And The Outcome

Inaam Faisal Mohammed; Bashar Akram AlBayati

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 450-455

Background: Acute Appendicitis is the most common non obstetric surgical emergency during pregnancy that can occur throughout pregnancy but difficulty in diagnosis and delayed treatment can be associated with adverse maternal and pregnancy outcome.
Patients and Method: A prospective, observational study conducted in the Department of General Surgery at Baquba Teaching Hospital – Diyala – Iraq, from April 2016 to April 2020. Seventeen pregnant women, with acute appendicitis, were included.The patients' age ranged from 19 - 39 years with a mean age of 25 years. The patients' history, operative findings, postoperative outcome and histopathology results were recorded and analyzed.
Result: Four patients were in the first trimester, 8 patients were in the second trimester while 5 patients were in the third trimester. Abdominal pain was the main symptoms in all patients followed by poor appetite and nausea, while the main physical signs were tenderness and rebound tenderness in right lower quadrant of the abdomen. The appendix was grossly inflamed in 16 patients and was normal in one patient as proved by histopathology. During the follow up period, 3 patients had surgical site infection (SSI) and treated conservatively, 2 patients had preterm contractions and treated by tocolytic drugs, while fetal loss occurred in one patient.
Conclusion: Acute appendicitis is a common surgical emergency during pregnancy but high degree of suspicion and skills are required for early diagnosis with subsequent proper management to avoid possible complications both to the fetus and the mother