Appendicectomies at a tertiary hospital: disease profile and surgical practices at Grey’s Hospital, Pietermaritzburg

Abstract

Introduction: The cause of acute appendicitis is probably multifactorial, and perforation may occur as the disease progresses. Appendicectomy is the treatment of choice and is increasingly being performed laparoscopically. Objectives: To determine the patients’ demographic and clinical characteristic, the commonest surgical approach, the prevalence of diagnostic inaccuracy and the association between perforated appendicitis and gender and age. Methods: A retrospective review of the medical records of 196 patients diagnosed with appendicitis at Grey’s hospital over an 18-month period was conducted. Data was collected on demographics, surgical approach, histology findings and complications. Results: Of the 196 patients, the mean age was 21.1 years, 54% were perforated, and the incidence of complicated appendicitis was highest at the extreme ages. Three surgical approaches were used: midline laparotomy (61.7%), Lanz incision (27.6%) and laparoscopy (10.7%). Bowel resection with primary anastomosis and stoma formation were done on 1.5% and 0.84% of cases respectively, while the abdomen was left open in 3.6% of cases. Although laparotomy was used for suspected perforated appendicitis, a small percentage of those who had midline laparotomy were, intraoperatively, found to have non-perforated appendicitis. Laparoscopic surgery was only used in a few selected cases of non-perforated appendicitis. The overall post-operative ICU admission was 9.7%. Conclusion: The majority of cases were perforated appendicitis. Midline laparotomy was the most preferred surgical approach despite its