Feasibility of Early Laparoscopic Appendicectomy in Appendicular Lump Patients: Experience from a Tertiary Care Centre
Abstract
Management of appendicular lump remains controversial. Traditional conservative therapy often requires prolonged hospitalisation, interval appendectomy, and carries risks of recurrence or missed alternative diagnoses. With advances in minimally invasive surgery, early laparoscopic appendectomy (ELA) has emerged as a potential single-stage alternative. This retrospective cohort study evaluated the safety and feasibility of ELA in patients presenting with an appendicular lump. The study was conducted from December 2013 to February 2024 at a tertiary care centre. Among 469 patients with acute appendicitis, 185 were identified with an appendicular lump based on clinical and radiological assessment. All patients underwent ELA within 24 hours using a standard three-port laparoscopic technique. Intraoperative findings, operative time, postoperative complications, length of stay, and histopathological outcomes were recorded, and all specimens underwent histopathological examination. Of 185 patients, 60% were male, with the most common age group being 20 - 40 years. Mean symptom duration was 5.36 days. Intraoperative findings included tip perforation in 62%, gangrene in 43%, localised abscess in 42%, and pyoperitoneum in 7.5%. Simple lumps were observed in 70% and complex lumps in 30% of cases. Mean operative time was 38 minutes (27 - 110 minutes). No patient required conversion to open surgery. Two patients required additional laparoscopic resections for extensive inflammatory involvement. Postoperative morbidity was low, with wound infection in 3%, wound dehiscence in 1%, paralytic ileus in 6%, and intra-abdominal abscess in 1.6%; no faecal fistula occurred. Mean hospital stay was three days (2 - 8 days). Histopathological examination confirmed acute appendicitis in all cases, with no alternative pathology identified. Early laparoscopic appendectomy for appendicular lump is safe, feasible, and effective in experienced hands. It provides low morbidity, acceptable operative duration, and short hospital stay, while avoiding the limitations of conservative management and interval surgery. ELA offers definitive single-admission treatment and may be considered a preferred approach in centres with established laparoscopic expertise.