Emergency Laparoscopic Appendectomy In Ghana: The 37 Military Hospital Method

Abstract

Summary: Emergency laparoscopic appendectomy is evolving as the method of preference for the management of acute appendicitis. Appendicitis is one of the common causes of acute abdomen diagnosed in the emergency unit in Ghana and open appendectomy
has been the preferred method for most surgeons. Increasing patient preference for laparoscopy in Ghana will soon require an increase in the practice of emergency laparoscopic appendectomy in many centres. The number and sizes of ports as well as the
site of placement, together with the technique of appendectomy, determines the uniqueness of the method of laparoscopic appendectomy. A simplified easy to apply method of laparoscopic appendectomy is needed to encourage its use in emergency centres.
Methods: The paper describes a 3-port method of laparoscopic appendectomy which combines the principles of open appendectomy and basic laparoscopy. Patient positioning and the operative removal of the appendix is similar to what as is done in open appendectomy. Pneumoperitoneum is achieved by open access through the umbilicus. Two additional ports are placed below the iliac crest for a good cosmetic effect. The amount of consumable used usage is comparable to that of open appendectomy. 
Discusion: The question of a gold standard procedure for laparoscopic appendix still persists. The key criteria in the choice of any method should be the success rate, affordability, resource availability and suitability. The method described meets the above criteria in a low resource environment. It offers opportunity for the practice of laparoscopic appendectomy in institutions that practice open appendectomy. The sites of port placement makes the method especially suitable for population that are keloid prone. The use of the same principle for mesappendix and appendix excision as in open appendectomy helps improve the learning curve. Modifying the 10mm port into a retrieval bag at the end of the procedure presents gives the same effect as a conventional retrieval bag without an additional risk of infection.
Conclusion: The method has an inherent easy learning curve and is expected to help scale up the conversion from open to laparoscopic appendectomy.