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Trends in Adoption of Laparoscopic Appendicectomy in a Developing Country: Closing the Gap

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

This study reviews our use of laparoscopic versus open appendicectomy over the last decade to track the trends in their usage in a middle-income country.

Methods

A retrospective study was conducted on patients with intraoperative confirmed acute appendicitis from January 2013 to December 2019 at Grey’s Hospital, Pietermaritzburg, South Africa.

Results

Eight hundred fifty-one cases of AA were included. 724 (85%) patients underwent open surgery; 435 (60%) via a midline incision and 194 (27%) via a local incision. 127 (15%) patients underwent laparoscopic appendicectomy. A significant rend was noted for an increasing proportion of surgery performed by laparoscopy compared to open surgery (p = 0.02). Patients who underwent open surgery compared to laparoscopy presented with greater peritonism (48.5% vs. 28%, p < 0.001), delay from symptom onset (3 vs. 2 days, p < 0.001), more frequently from rural areas (94% vs. 86%, p = 0.002) and with higher AAST scores (46.7% AAST ≥ 4, vs. 14.9%, p < 0.001). This former group had significantly greater morbidity (42% vs. 35%, p < 0.001) with higher Clavien-Dindo scores, were more likely to require ICU admission (8.3% vs. 2.3%, p < 0.001) and have longer hospital stay (4 days vs. 2 days, p < 0.001); no statistically significant difference in mortality was observed (1.1% vs. 0.8%, p = 0.75).

Conclusions

There has been a steady increase in the uptake of laparoscopic appendicectomy and decrease in open approaches in our centre. There is still a high rate of patients with advanced disease, and it is unlikely that this cohort will be suitable for laparoscopic surgery. If we hope to increase the uptake of laparoscopic surgery for acute appendicitis even further, we must focus on identifying patients with early and low-grade disease.

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Authors and Affiliations

  1. Department of Surgery, University of KwaZulu Natal, Durban, South Africa

    Maheshwar Naidoo, Vishendran Govindasamy, Ash Dasrath, Bob Mills, John Bruce, Grant Laing & Damian Clarke

  2. Mental Health and Addictions, Waikato Hospital, Hamilton, New Zealand

    Varun Thirayan

  3. Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa

    Victor Kong

Authors
  1. Maheshwar Naidoo
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  2. Varun Thirayan
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  3. Victor Kong
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  4. Vishendran Govindasamy
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  5. Ash Dasrath
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  6. Bob Mills
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  7. John Bruce
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  8. Grant Laing
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  9. Damian Clarke
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Corresponding author

Correspondence to Varun Thirayan.

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Naidoo, M., Thirayan, V., Kong, V. et al. Trends in Adoption of Laparoscopic Appendicectomy in a Developing Country: Closing the Gap. World J Surg 46, 1015–1021 (2022). https://doi.org/10.1007/s00268-022-06454-8

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  • DOI: https://doi.org/10.1007/s00268-022-06454-8

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