Port Site Infection after Laparoscopic Appendectomy: Resected Appendix Removal in Glove Versus Direct Removal through Port Site

Abstract

Background: Minimal access surgery or laparoscopic surgery(LS) has brought a paradigm shift in the history of surgery and has
gain popularity among patients and surgeons in term of early recovery and less complications. The port site infection (PSI) rate of umbilical port is 11% in case of laparoscopic appendectomy.
Objectives: To compare the PSI rate in patients who underwent laparoscopic appendectomy in whom appendix was retrieved in a
bag versus those in whom it was extracted directly through port site.
Material & Methods: This randomized control trial was conducted at department of surgery Saidu teaching hospital Swat, in two
years. 100 patients who were diagnosed as cases of acute appendicitis were included in study and allocated to group A or B by block technique, keeping the type of appendicitis same in both groups. All patients' underwent 3 ports standard laparoscopic appendectomy. In group A resected appendix was removed after it has been putted in a glove and the glove being closed before removing on umbilical port site while in group B it was removed directly on umbilical port site without covering appendix before removal. Data was collected and analyzed by using SPSS 21.
Results: Average operating time was 55.6 minutes in group A while in group B it was 53.6 minutes. Maximum patients presented with catarrhal appendicitis(62%) followed by suppurative (38%)in both groups A and B.Average hospital stay was 1.8days in group A patients while in group B it was 2.2days (P value 0.04). Port site infection was 4% in group A while 14% in group B patients with P value of 0.0006.
Conclusion: PSI rate is significantly high in those patients in whom resected appendix is removed directly through umbilical port site than those in whom resected appendix was removed after it has been putted in a glove before removing on umbilical port site.