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22Jassim Mohamed Khalaf
M. B. Ch. B. A. B. H. S. (General Surgery) Ministry of Health - Department of Health Al-Anbar - Al-Ramadi
Teaching Hospital, Al-Anbar, Iraq.
Asaad Oleiwi Khalaf M. B. Ch. B. F. I. C. M. S.
Ministry of Health - Department of Health Al-Anbar - Al Qa'im
General Hospital, Al-Anbar, Iraq.
Ahmed Qasim Zighir M. B. Ch. B. F. I. C. M. S.
Ministry of Health - Department of Health Al-Anbar - Heet General
Hospital, Al-Anbar, Iraq.
DOI: 10.24412/2520-6990-2021-592-65-71 COMPARATIVE STUDY BETWEEN COMPLICATIONS AFTER LAPAROSCOPIC AND OPEN
APPENDECTOMY
Abstract
This is a painful swelling of the appendix of the cecum; a finger-like sac that connects to the large intestine, on the right side lower abdomen complications and, in most cases, peritonitis can be treated by prompt removal of the appendix and cleaning inside the abdomen to prevent inflammation. Without prompt treatment, peritonitis can cause death.
Appendicitis occurs when swollen lymph nodes in the appendix wall due to gastrointestinal infections or any mean in the body or blockage of the lumen of the appendix due to bacteria that interact within it, causing it to enlarge and its inflammation.
The data collected was studied at Ramadi teaching hospital from 600 patients, of whom 400 underwent a conventional appendectomy, and 200 patients were treated with laparoscopy and it was called by this name, the removal of this existing appendix Near the area where the small intestine and the large intestine connects in the human body, which ranges from 5 meters in length To 11 cm does not cause complications and harm to the body, which means that it has no role, The appendix can be removed using two different techniques Laparoscopic surgery It is the most common technique in which a surgeon performs three or four incisions Small incisions (incisions) in the abdomen and the appendix is removed from a small camera known as an endoscope Using special surgical tools, The surgeon then sutures the large intestine, which was the appendix Adhesive tapes are attached to them and seal the cracks with steri-strips and The second technique is open surgery (a few the surgeon cuts the right abdomen, and cuts a small lower abdomen the appendix removes the appendix through it and then bandages the wound with strips-steri
Key words Laparoscopic, Open Appendectomy, Complications, abdominal, Parenteral analgesics
Introduction
Acute appendicitis is a disease that is more common among men than it is in women with a ratio of 3: 2, especially in the second and third decades of life. Appendicitis remains, despite the technological development of diagnostic methods, a very difficult problem to diagnose, which requires immediate surgery, Which in particularly difficult cases may lead to death and the appendix develops as an extension of the primary large intestine (cecum), and is present in 95% of cases inside the peritoneum, but it can be present in different positions relative to the membrane. The length of the appendix may be about 10 cm. Acute appendicitis is caused by inflammation that forms due to blockage of the appendix cavity, in which infections may appear in its wake, and acute appendicitis remains within the scope of an acute, difficult to diagnose emergency that requires Surgery, therefore, sometimes-additional diagnostic methods are used.
Symptoms of acute appendicitis include:
• Abdominal pain that begins in the navel area and over time moves to the lower right abdomen.
• Nausea and vomiting
• Swollen belly
• Constipation
• Pain when touching the right abdomen
• High temperature
• Gas and problem to take it out
• Changes in the normal functioning of the intestine (diagnosed by the attending physician).
If symptoms of chronic appendicitis appear, do not take laxatives (Laxatives) or do an enema in order to relieve constipation. These medicines significantly increase the possibility of the appendix bursting Also; it is necessary to refrain from taking pain-relieving drugs before the medical examination so that these drugs do not hide the presence of pain and thus lead to a wrong diagnosis.
The appendix is defined as a small finger-shaped follicle that connects to the large intestine in the lower right side of the abdomen, and appendicitis is one of the main causes of suffering from sudden severe abdominal pain. As this condition requires surgery, and this inflammation is accompanied by the appendix filling with pus; which is a fluid made of dead cells and inflammatory tissue, which is often caused by infection
Symptoms of the appendix Appendicitis is associated with a group of symptoms, including the following
• Abdominal pain: It is considered the most common symptom of appendicitis, and the following are the most prominent characteristics of this pain: The pain begins near the navel area and then moves to the lower abdomen and to the right side of it. The pain gets worse within hours.
• The severity of the pain worsens when moving, coughing, sneezing, or taking a deep breath. The patient describes this type of pain as severe and different from other types of pain he felt throughout his previous life.
• The pain occurs suddenly and may wake a person from sleep.
• Pain occurs at first, with other symptoms preceding it.
It should be noted that symptoms may differ from one person to another so that they appear similar to other conditions that may cause abdominal pain, such as abdominal adhesions, constipation, intestinal obstruction, Pelvic inflammatory disease or Inflammatory bowel disease, which includes Crohn's disease) Ulcer-ative colitis, long-term disorders responsible for irritation and ulceration in the digestive tract. [2]
Causes of the appendix
The cause of appendicitis is often unknown, and there are many reasons that together may lead to the occurrence of this type of inflammation, and it is believed that the obstruction of the appendix, whether complete or partial obstruction, is the cause of this inflammation, and there is no doubt that Complete blockage requires prompt action; And resorted to solve this problem through urgent surgery, and it is reported that the blockage of the appendix may be attributed to many cases; Such as: the growth of tumors, the presence of worms, the accumulation of fecal matter in them, the enlargement of the lymph follicles, or exposure to an injury or blow, and it should be noted that a blockage in the appendix may cause the proliferation of bacteria inside it, and this leads to the formation of pus, apart from That the increased pressure would cause a feeling of pain, or pressure on the blood vessels in this organ, and in the context of this conversation we point out that the reduced blood flow to the appendix may cause gangrene. [3] The appendix may rupture, causing the abdomen to fill with fecal matter, Here call on the necessity of receiving appropriate immediate medical procedures in this case, as the rupture of the appendix may lead to suffering from many other complications. Peritonitis or inflammation of other organs; Including the cecum, the bladder, and the sigmoid colon, and in the context of this talk we refer to the possibility of Abscess formation in the event that the components of the inflamed appendix leak rather than rupture, and this leads to the infection being confined to a small, limited area of the extremities, and although it is confined to a limited area, the abscesses It's also considered a serious condition.
Diagnosis of appendicitis
Often he needs knowledge of the patient's health history to diagnose appendicitis, in addition to his need to conduct some checks and tests, including the following: [4]
A. Physical test: The doctor examines the patient Physical Examination to find out the location of the pain, and the possibility of infection and inflammation spreading to the peritoneum, and he may examine Rectum.
B. Blood test: The doctor requests a blood test to detect the state of White Blood Cells, as its height gives an impression of infection of the body.
C. Urine test: Urine test is required by a physician to rule out other conditions that cause similar pain, such as Urinary Tract Infections and Kidney Stones.
D. Radiographs: The doctor may order some radiographs to detect other possible causes of pain, or to confirm the presence of inflammation in the appendix, including X-rays, Computed Tomography and Abdominal Ultrasound
Treatment of appendicitis
Appendicitis can be treated in one of the following ways:
Antibiotics: Although some scientists believe that the patient's antibiotics can control his appendicitis in simple and uncomplicated cases; However, some others have disagreed with this idea, and accordingly, the adoption of antibiotics is still required for further studies.
Surgery An inflamed appendix can be removed by one of the following types of surgery:
A. Laparoscopy
Laparoscopy, in which the doctor inserts an endoscope in the form of a thin tube with a small camera and a light, so that can see clearly inside the abdomen, and the inflamed appendix can be removed by making a small incision in the abdomen. It is worth noting that the patient recovers quickly after this operation and the scars are minor.
B. Laparotomy
Can resort to the option of surgery by opening the abdomen, and after the operation the patient is given intravenous antibiotics, and among the cases in which the option of opening the abdomen is used.
1. Appendix burial
2. The infection spreads in the abdomen.
3. The appendix causes an abscess to form.
4. The patient suffers from tumors in the digestive system.
5. Pregnancy female in the last trimester.
6. The patient had undergone many abdominal surgeries before this time.
Effects after an appendix operation
The time required to recover from an appendix operation - which is medically known as an appendectomy - depends on a number of different factors, such as the type of operation that was performed, the type of anesthesia, the health complications that may accompany the operation, in addition to the occurrence of a rupture of the appendix before the excision. Laparo-scopic appendectomy, the affected person does not
need to stay in the hospital, and can often return home on the same day, but in the case of an open appendectomy, which is a large incision in the abdomen to remove the appendix Worm, a person may need to stay in the hospital for several days, and despite the ability to do normal daily activities within several days, complete recovery from the process may require a period ranging from 4-6 weeks, and the affected person needs a longer period and the use of one Antibiotics in the event the appendix ruptures, and there are some tips that may help achieve a cure, we will mention the following:
A. Avoid carrying heavy weights.
B. Wash your hands well before touching the wound area.
C. Follow your doctor's instructions about being able to shower.
D. Checking for signs of infection in the wound area, such as thick and strong-smelling secretions, or redness and pain in the wound area.
E. Take a pain reliever.
F. Light pressure on the abdomen with a pillow before coughing, or moving to relieve pressure on the wound area.
Complications because of the appendix operation
• Abscess in the abdomen: resulting from the operation and may be the result of infections in the operation wound or as a result of the operation itself. This can happen in any hospital and with any doctor, because if the appendix bursts and the abscess comes out in the abdomen, strong infections may result. Upon delay in receiving treatment, this condition may lead to blood poisoning and a "septic or septic shock", which is responsible for hypotension, deterioration of lung and kidney function, and thus causing death.
• Complications due to the antibiotic: Some germs produce this abscess are resistant to antibiotics, which causes delay in treatment due to the administration of an antibiotic that is not resistant to these germs. This condition leads to a deterioration of the patient's condition.
• Antibiotics that are given in cases of surgery or any other reason that may produce a germ that causes inflammation in the intestine called clostridium difficult and causes acute infections and diarrhea, and in some rare cases it leads to a deterioration of the intestinal condition and consequently infection and death.
Method
The initial two gatherings were acquired, called open appendectomy (OA) and a gathering of laparo-scopic appendectomy (LA). The information remembered illnesses for expansion to that time during which the activity was performed and the outcomes acquired from the activity and it was not restricted to this, yet additionally included to Complications that happen after the activity.
The conclusion was made clinically through history (right iliac fossa or agony around the navel, quea-siness/spewing) and actual assessment (delicacy or feeling in the privilege iliac fossa). In patients for
whom a clinical determination couldn't be resolved, imaging studies, for example, stomach ultrasound or tomography were performed, and the two gatherings of patients were given a third-age prophylactic portion of cephalosporin and endless supply of general sedation as a component of an OA convention performed through the cut. Macintosh Burnie benchmark. After the cut, the peritoneum was gotten to and opened to convey the addendum, which was eliminated in the standard way. A standard three-port strategy was utilized for the lapa-roscopy set. The pneumothorax was created at a steady pressing factor of 12-14 mmHg of carbon dioxide through the Ferris channel, put at a site underneath the umbilicus. The patient was put in the Trendelenburg position, with a slight left turn.
The stomach pit was analyzed to avoid different infections inside the midsection or pelvis. Subsequent to partitioning the informative supplement with bipolar forceps, the base of the addendum was gotten with two circles of designation, trailed by a distal analyzation of the subsequent ring. At that point, the distal affixed stump was shut to dodge the danger of a purulent or intestinal emission.
The example is set in an internal pack and recovered through a port under the navel 10 mm. All examples were sent for histopathology.
Patients were not given oral nourishment until they completely recuperated from sedation and entrail sounds endless supply of clear liquids. The lean eating regimen was presented when patients endured the fluid eating routine and were gotten free from stomach gases.
The patients were released from the medical clinic when they had the option to follow an ordinary eating regimen, and had a fever and great torment control.
The activity time (in minutes) was determined for the two methods from the skin cut to the last skin join applied, and the length of emergency clinic stay was controlled by the quantity of evenings spent in the emergency clinic after medical procedure. Wound contamination has been characterized as redness, purulent or purulent release from the site of the cut. Serum was characterized as neighborhood growing without redness with clear liquid splash Paralytic ileus was characterized as inability to restore inside sounds inside 12 hours after medical procedure
Results
Categorical data were presented as frequencies and percentage and compared to Chi-square test Continuous parametric and non-parametric data were presented as mean deviation and standard deviation and were evaluated by Student's t-test and Mann - Whitney U test respectively. Comparisons were made between the two groups on an intention-to-treat basis. Consequently, patients in the group were not excluded with the help of endoscopes referred to the open procedure from the analysis.
The sample size was calculated for our study based on analysis of sample sizes required for each of the parameters (operation time, length of hospital stay, post-operative pain, complication rate, return to normal activity and cost) for a = 0.05 and a strength of 90%. A
P-value of 0.05 was considered significant. All calculations were performed with SPSS software package version 17.0 (SPSS Inc., Chicago, IL).
Table 1
Demographic and preoperative clinical data
Open appendectomy (n = 400) Laparoscopic appendectomy (n = 200) P
Mean age 30.66 ± 16.14 28.66 ± 15.28 0.49
WBC count (per mm3) 14808±4579 13257±5399 0.002
Co-morbidities 0.236
CAD (1.7) (1.6)
Hypertension (5.9) (3.2)
COPD (2.8) (2.3)
DM (3.6) (1.5)
-0,2
-0,1
0,1
0,2
0,3
0,4
0,5
0,6
0,7
ser2 Iserl
1 0 0,49
2 0
0,002
3 0
0,236
0
■ ser2 Bserl
Figure 1- distribution of p value
Table 2
Laparoscopic versus open appendectomy
Open appendectomy (n = 400) Laparoscopic appendectomy (n = 200) p
Surgical findings, n (%) 0.074
Uncomplicated acute appendicitis 250 (68.8) 150 (84.8) 0.056
Appendiceal abscess 100 (13.1) 27 (7.5) 0.03
Gangrenous appendicitis 60 (7.5) 13 (4.1) 0.002
Peritonitis 40 (10.8) 10 (2.8) 0.342
Table 3
Clinical, surgical and postoperative data
Open appendectomy Laparoscopic appendectomy P-value
Operative time (min) 33.22 ± 15.41 53.8 ± 13.9 <0.0001
Time until diet (1st POD) 188 (61.9) 238 (85.2) <0.001
Parenteral analgesics (doses/day) 1.6 ± 0.7 1.1 ± 0.4 0.001
Oral analgesics (doses/day) 2.2 ± 2.88 1.77 ± 1.88 <0.0001
Hospital Stay (day) 2.5 ± 2.3 1.6 ± 0.5 0.015
Return to normal activity (day) 15.8 ± 3.7 12.2 ± 3.7 <0.001
* ser4 ■ ser3 * ser2 ■ serl
Figure 2- Graphic distribution of Mean±SD surgical and postoperative data
Table 4
Comparison of complications after the operation
complications Open (n = 70) Laparoscopic (n = 22) P
Minor
Vomiting 14 (21.6) 10 (41.3) 0.531
Paralytic ileus 10 (15.1) 5 (26.3) 0.417
Wound infection 32 (42.8) 2 (12.9) 0.001
Major
Wound dehiscence 10 (18.1) 0 (0.0) 0.001
Intra-abdominal abscess 2 (1.5) 3 (13.5) 0.210
Hemoperitoneum 2 (1.5) 0 (0.0) 0.321
45 40 35 30 25 20 15 10 5 0
1 2 3 4 5 6
□ Laparoscopic 41,3 26,3 12,9 0 1,5 0
□ n 10 5 2 0 3 0
open 21,6 15,1 42,8 18,1 1,5 1,5
□ n 14 10 32 10 2 2
□ complications 0 0 0 0 0 0
□ Laparoscopic □ n Dopen □ n □ complications
Figure 3- It shows the nature of the distribution complications after the operation
Discussion
An appendectomy in acute appendicitis is a common emergency surgical procedure. Open appendectomy has been the gold standard treatment for acute appendicitis since MacBurney's prescription in 1894. Although appendectomy is considered a safe procedure, complications are possible. Among the most prominent are wound infection, intra-abdominal abscess, adhesions, intestinal obstruction, and pulmonary complications from general anesthesia.
Since its first description in 1983, laparoscopic appendectomy has gained popularity with accumulating evidence demonstrating the benefits of the laparoscopic approach in terms of shorter hospital stays, faster recovery, and better post-operative pain control. Moreover, laparoscopy allows a complete and comprehensive evaluation of the abdominal cavity and increases diagnostic accuracy, especially in females where rates of appendectomy with normal tissues have been very high.
The development of an intra-abdominal abscess after surgery (IAA) after an appendectomy is a rare and serious complication and is associated with significant morbidity. Some reports indicated an increased risk of developing an intra-abdominal abscess after laparo-scopic appendectomy compared to open surgery, while others reported the opposite.
Acute appendicitis is the most common intra-ab-dominal condition that requires emergency surgery The possibility of developing appendicitis must be considered in any patient with an acute abdomen, and preoperative diagnosis remains a challenge [28, 29]. Although more than 20 years have passed since the introduction of laparoscopic appendectomy (performed by the gynecologist Semm in 1983), open appendectomy is still the traditional method. Some authors consider emergency laparoscopy as a promising tool for treating abdominal
emergencies capable of reducing costs and intervention, maximizing outcomes and patient comfort
Several studies have shown that laparoscopic appendectomy is safe and leads to a faster return to normal activities with fewer wound complications These results were challenged by other authors who noted no significant difference in outcome between the two procedures, and noted higher costs with laparoscopic appendectomy.
Conclusion
Appendicitis is a painful medical condition that can rupture the inflamed appendix. When the appendix ruptures If the patient is infected, pus leaks out and the infection moves to the abdominal cavity, and this may lead to inflammation The peritoneum, which is an inflammation of the abdominal cavity, and inflammatory complications include failure of the body's organs And death, so treatment of peritonitis requires emergency surgery when the appendix ruptures Appendicitis does not respond well to antibiotic treatment. So the most treatment method Commonly, surgery can be performed by opening or laparoscopy, which is an appendectomy will determine the appropriate type for the patient's condition Appendectomy is a very safe and successful surgery. Its risks and complications are very rare, Knowing these risks and the signs may help them to be detected and addressed early
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Ahmed Qasim Zighir
M. B. Ch. B. F. I. C. M. S.
Ministry of Health - Department of Health Al-Anbar - Heet General
Hospital, Al-Anbar, Iraq. Jassim Mohamed Khalaf M. B. Ch. B. A. B. H. S. (General Surgery) Ministry of Health - Department of Health Al-Anbar - Al-Ramadi
Teaching Hospital, Al-Anbar, Iraq.
Asaad Oleiwi Khalaf M. B. Ch. B. F. I. C. M. S.
Ministry of Health - Department of Health Al-Anbar - Al Qa'im
General Hospital, Al-Anbar, Iraq.
DOI: 10.24412/2520-6990-2021-592-71-76 RISK AND INCIDENCE RATE FOR COLORECTAL CANCER PATIENTS IN AL-ANBAR CENTER
FOR ONCOLOGY.
Abstract
This disease is grouped into various sorts as indicated by the dangerous cells. In by far most of cases (over 95%), this is a sort of disease called "adenocarcinoma". Uncommon sicknesses are: lymphoma, carcinoid, melanoma and sarcoma - metastasis of connective tissue or its subordinates Sarcoma Colon and rectal malignant growth is a difficult medical condition. It is extremely normal and has high paces of dreariness and mortality, arriving at half of patients who create it. In one year, in excess of 1,000,000 individuals overall are required to pass on from this sickness. During the primary decade of the 21st century, colorectal malignancy was the main source of death, and considerably more than the demise rate from coronary illness. Today, this sort has the most elevated commonness of disease executioners. In one year, in excess of3,000 new cases show up, and the normal loss of life is 1,200-1,500 individuals. On the off chance that colorectal malignancy is analyzed at a high level stage, the possibility of recuperation is near nothing, while in the event that it is analyzed at a beginning phase, the fix rate is over 95%, Colon and rectal disease is the effect of unnerving sicknesses, as it is named the third basic illness. Early recognition assessments and treatment alternatives have decreased the CRC death rate in created nations, even with expanding frequency. Better hereditary testing and documentation of a family ancestry
