The Egyptian Journal of Hospital Medicine (January 2018) Vol.

70 (2), Page 308-311

Length of Stay and Patient Satisfaction after Appendectomy

Momen Hadi S. Shawk1, Ali Mansour Taher Sumayli 1, Mohammad Ali Mousa Daghriri 1,
Khormi Ahmed Hadi A 1, Mohammad Abdu sulaiman 2, Saud Abdulaziz Musa Alqahtani 1,
Alhazmi Ali Mohammed N 1, Altaher Ahmed Hassan A 1
1. Jazan University, 2. Ibn sina college
ABSTRACT
Objective: This review to show the degree of patient satisfaction and length of stay after laparoscopic
appendectomy or open appendectomy. Moreover, the degree of appendicitis was considered either acute
appendicitis or perforated appendicitis which can result in complications like sepsis, peritonitis and
gangrene. Data sources: (PubMed, Google Scholar) have been searched for papers that addressed patient
satisfaction and length of stay after appendectomy, preoperative appendicitis status and the operation used
for appendectomy were considered during searching. Results: It was obvious that patient who have
undergone laparoscopic appendectomy were more satisfied and had short length of stay after the operation
neither than patients who have undergone open appendectomy who were less satisfied and had longer
length of stay. Also, it was clear that patient with acute appendicitis were more satisfied with short length
of stay neither than patients with perforated appendicitis who were less satisfied with longer length of stay.
Keywords: appendectomy, satisfaction, acute appendicitis, perforated appendicitis.

INTRODUCTION
Appendicitis is inflammation of the appendix. It Although the symptoms of appendicitis are the
may be acute or chronic. It’s more common in same for adolescents as they are for adults, they
males than in females. Appendicitis is the most may begin differently. In adolescents,
common reason for abdominal surgery in appendicitis can begin as a vague stomachache
children. About four of every 1,000 children near the navel. This pain may progress to the
under the age of 14 will undergo surgery called lower right side of the abdomen.
an appendectomy to remove their appendix. The study was done after approval of ethical
Appendicitis rarely occurs in children under the board of Jazan university.
age of two, and mostly occurs in people between Causes of appendicitis
the ages of 15 and 30. In many cases, the cause for appendicitis is
symptoms of appendicitis. unknown. There can also be multiple causes for
 Nausea one case of appendicitis1.
 Vomiting Doctors believe an obstruction in the appendix
 Pain when touched on the lower right side of may cause appendicitis. Obstruction may be
the abdomen either partial or complete. Complete obstruction
 Abdominal pain or tenderness, usually in the is a cause for emergency surgery.
center of the abdomen above the belly Obstruction is often due to an accumulation of
button, then shifting to the lower right fecal matter. It can also be the result of:
side of the abdomen. The pain increases  enlarged lymphoid follicles
when moving, taking deep breaths,  worms
coughing, or sneezing.  trauma
 Fever, usually low-grade (under 100 degrees)  tumors
 Inability to pass gas Types of appendicitis
 Diarrhea 1-Acute appendicitis:
 Constipation IT is an inflammation of the appendix and is one
 Abdominal swelling of the most frequent causes of acute abdominal
 Lack of appetite pain. It is often treated surgically as an
If symptoms of appendicitis appear, it is emergency. As we still do not know the real
important that the patient does not take laxatives reason behind the occurrence of acute
or enemas to relieve constipation. These appendicitis, it needs to be treated cautiously.
medications could cause the appendix to burst. Some may get it because of an obstruction of
Patient should also avoid taking pain medications food or fecal matter; others may get it due to an
that could mask the symptoms. The doctor would infection2. Under certain conditions, the bacteria
need to know the diagnosis of the condition. may multiply within the appendix. The appendix
may swell, and become filled with pus, and

308
Received: 12/10/2017 DOI: 10.12816/0043096
Accepted: 22/10/2017
 Momen Shawk et al.

eventually rupture. Whatever the reason, Peritonitis is another possible consequence of a

immediate medical aid is required as this is a life ruptured appendix. It’s an inflammation of the
threatening situation. Although the cause of tissue that lines the abdominal wall. Other organs
appendicitis is not completely explored, it has can also become inflamed after a rupture.
been established that after surgical removal of Affected organs may include the cecum, bladder,
the appendix, a person can live a healthy and and sigmoid colon.
normal life 3 .But, when the appendix bursts If the infected appendix leaks instead of ruptures,
inside the body, all the infection contained within it can form an abscess. This confines the
it gets released into the abdominal area. The infection to a small walled off area. However, an
consequences of this are very serious, and you abscess can still be dangerous.
need to be treated with antibiotics immediately. Treatment:
Appendicitis is the most common acute surgical 1-laparoscopic appendectomy
procedure carried out on the abdomen. The appendix is removed by laparoscope through
2-Chronic Appendicitis: an incision in the right lower abdominal wall.
Although acute appendicitis is more common In most laparoscopic appendectomies, surgeons
and develops quickly, chronic appendicitis is operate through 3 small incisions (each ¼ to ½
more rare and much slower. Therefore, when it inch) while watching an enlarged image of the
comes to chronic appendicitis, timely recognition patient’s internal organs on a television monitor 5
of the condition and treatment becomes a . In some cases, one of the small openings may
difficult job. be lengthened to complete the procedure.
Some people with chronic appendicitis may only
feel fatigue and mild pain in their stomach. It is Advantages of laparoscopic appendectomy
natural to confuse this condition with a common Results may vary depending upon the type of
stomach flu or virus. If discovered in time, it can procedure and patient’s overall condition 6 .
be treated with powerful antibiotics, saving the Common advantages are.
patient is the need to undergo surgery. Just  Less postoperative pain
because it takes longer to recognize the  May shorten hospital stay
symptoms, does not mean chronic appendicitis  May result in a quicker return to bowel
should be taken lightly. Fever, intense pain and function
nausea are generally not the symptoms of chronic  Quicker return to normal activity
appendicitis; therefore there is a big chance that  Better cosmetic results
it might go unnoticed. Due to the slow progress  Patient satisfaction is high
of chronic appendicitis, you will find that Although laparoscopic appendectomy has many
infection may spread all over the abdominal area. benefits, it may not be appropriate for some
The symptoms often vary from patient to patient; patients 7 . Early, non-ruptured appendicitis
therefore, only a doctor can diagnose it correctly. usually can be removed laparoscopically.
Many say a healthy diet will reduce the chances Laparoscopic appendectomy is more difficult to
of chronic appendicitis, but this is not always the perform if there is advanced infection or the
case. Just because you tend to live a healthy life appendix has ruptured. A traditional, open
and include lots of vegetables and fruit in your procedure using a larger incision may be required
diet, does not mean the chances of getting to safely remove the infected appendix in these
chronic appendicitis are completely eliminated. patients.
The only real difference between acute and 2-Open appendectomy
chronic appendicitis is that chronic appendicitis Open appendectomy involves making a 2-4
takes longer to develop but is just as lethal. inch deep incision on the right side of the lower
3-Perforated appendicitis. abdomen. The appendix is separated from the
When there’s an obstruction in your appendix, surrounding abdominal organs, cut and then
bacteria can multiply inside the organ. This leads removed. The stump (small part of the appendix
to the formation of pus. The increased pressure that remains after the cut) is either inverted or
can be painful. It can also compress local blood cauterized 8. The abdominal wall is then closed
vessels. A lack of blood flow to the appendix and the skin sutured.
may cause gangrene. Acoording to Sauerland et al. in case the
If the appendix ruptures, fecal matter can fill appendix has already ruptured; further
the abdomen. This is a medical emergency 4. management varies depending upon the severity
of infection and inflammation, whether there is

309
 Length of Stay and Patient Satisfaction…

an abscess (pus formation) or a phlegmon Comparison between laparoscopic and open

(inflammatory mass) appendectomy (2,10,11)
In that situation, the surgeon decides upon the Laparoscopic
treatment based on various other factors 9 Open appendectomy
appendectomy
An open appendectomy surgery is performed: Acute Perforated appendicitis
* in case there is an infection/inflammation of Indications
appendicitis with infected field.
the appendix, called an appendicitis
* the person suffers from severe pain (initially Post Painful and patient
around the umbilicus and then radiating to the operative Low pain requires postoperative
lower aspect of the right side abdomen) pain analgesics
accompanied by a host of other symptoms Post Less or no May happen like
*these could include nausea, vomiting, loss of operative postoperative :abcess,pnemonia,heart
appetite, fever, and chills. complications complications proplems.
Risks and Complications after open Better
appendectomy surgical procedure. esthetics with Lower esthetics with
Esthetics
*Abscess formation in the abdominal cavity less scar usual scar formation
*In case of pregnant women, there is a 5% formation
chance of losing the fetus (4-5) days,but full
Length of Few days (2-
*Pneumonia recovery may take 3
stay 3)days
*Blood clot formation weeks.
*Heart problems Not high specially if
Patient Considered
Open appendectomy operation takes about 90 complications
satisfaction High
minutes and time for patient to be fully happened
recovered about 3 weeks 10 .This longer time
absolutely decreases the patient satisfaction.

Figure 1: length of stay after appendectomy (comparison between laparoscopic and open appendectomy)

310
 Momen Shawk et al.

Figure 2: Incidence of various postoperative complications and total complications in the laparoscopic and
open appendectomy

CONCLUSION 3. Pier A, Götz F, Bacher C(1991): Laparoscopic

We concluded that the degree of patient appendectomy in 625 cases: from innovation to routine,34:
8-13
satisfaction and length of stay after appendectomy 4. Saye WB, Rives DA, Cochran EB(1991): Laparoscopic
is variable between patients according to the status appendectomy: three years' experience. Surgical
of the appendicitis and the operation selected for Laparoscopy Endoscopy & Percutaneous
appendectomy. It has been shown that acute Techniques,1(2):109-15.
5. Nowzaradan Y, Westmoreland J, McCARVER CT,
appendicitis with less infection has better results Harris RJ (1991): Laparoscopic appendectomy for acute
after appendectomy with less postoperative appendicitis: indications and current use. Journal of
complications rather than perforated appendicitis laparoendoscopic surgery, 1(5):247-57.
with infection or abcess formation. 6. Attwood SE, Hill AD, Murphy PG, Thornton J,
The technique chosen for operation to case with Stephens RB(1992): A prospective randomized trial of
laparoscopic versus open appendectomy.
acute appendicitis is usually laparoscopic Surgery,112(3):497-501.
appendectomy which gives better results with less 7. Henle KP, Beller S, Rechner J, Zerz A, Szinicz G,
pain and short length of stay and high patient Klingler A(1996): Laparoscopic versus conventional
satisfaction. Whether,in perforated appendicitis appendectomy: a prospective randomized study. Der
Chirurg; Zeitschrift fur alle Gebiete der operativen
with infected field and abcess formation,open Medizen,67(5):526-30.
appendectomy is preferred and drain may be used 8. Ortega AE, Hunter JG, Peters JH, Swanstrom LL,
,but it was shown that this technique has some Schirmer B(1995): Laparoscopic Appendectomy Study
drawbacks like :formation of post-operative Group. A prospective, randomized comparison of
complications ,painful to the patient, longer length laparoscopic appendectomy with open appendectomy. The
American journal of surgery, 169(2):208-13.
of stay,less patient satisfaction. 9. Lejus C, Delile L, Plattner V, Baron M, Guillou S,
Ethical statement Heloury Y, Souron R(1996): Randomized, Single-blinded
This review article does not require ethical Trial of Laparoscopic Versus Open Appendectomy in
approval. ChildrenEffects on Postoperative Analgesia.
Anesthesiology: The Journal of the American Society of
CONFLICT OF INTEREST Anesthesiologists,84(4):801-6.
The author of this manuscript has no conflict of 10. Frazee RC, Roberts JW, Symmonds RE, Snyder SK,
interest to declare. Hendricks JC, Smith RW, Harrison JB(1994): A
prospective randomized trial comparing open versus
REFERENCES laparoscopic appendectomy. Annals of surgery,219(6):725.
1. Merhoff, Merhoff, Franklin (2000): Laparoscopic versus 11. Hansen JB, Smithers BM, Schache D, Wall DR, Miller
open appendectomy. Am J Surg.,179(5): 375–378. BJ, MenZies BL(1996): Laparoscopic versus open
2. McAnena , Austin o, Hederman(1991): Laparoscopic appendectomy: prospective randomized trial. World journal
versus open appendectomy. Lancet,67:338:693 of surgery, 20(1):17-21.

311