Ramírez CFJ, Acosta PLE,Arizpe BD

Language: Spanish
References: 8
Page: 123-127
PDF size: 357.26 Kb.

ABSTRACT

Introduction: Early diagnosis and opportune surgical approach are the most important objectives in acute appendicitis. Objectives: To demonstrate that laparoscopic appendectomy with the use of surgical stapler for closure of the appendix stump is a safe and reliable procedure. Material and methods: The patients included in this study were those that received medical attention through the Emergency Room at Hospital Angeles de Puebla between January 2010 through January 2015 with the diagnosis of acute appendicitis and intervened by the same surgical team using the laparoscopic approach and stapler technique. A multivariate analysis was performed on general demographics, clinical evolution, operative time, conversions, appendicitis course staging and leakage complications with a follow up of 6 months. Results: 143 patients were included within a 5-year period, 78 males and 65 females, with ages from 15 to 56 years with a clinical evolution range from 12 to 72 hours. Simple CT scan was performed on 63% of the patients, being consistent with our clinical diagnosis in 100%. Pneumoperitoneum was achieved using a Veress needle in 2 patients and through the open Hasson technique in 141 patients. A 30 degrees and 3 mm laparoscopic lens was used in all cases. The hospital stay was 1-3 days and no conversions to open surgery are reported. There were one postoperative intraabdominal abscess and one surgical site infection in a port incision with no appendix stump leakage or fistula. Conclusions: Laparoscopic appendectomy with the use of surgical stapler for closure of the appendix stump is a safe and reliable procedure even in advanced stages of acute appendicitis.

REFERENCES

1. Rakić M, Jukić M, Pogorelić Z, Mrklić I, Kliček R, Družijanić N et al. Analysis of endoloops and endostaples for closing the appendiceal stump during laparoscopic appendectomy. Surg Today. 2014; 44: 1716-1722.

2. Fluke LM, Ottino J, Zarow GJ, Held J, Neubauer DC, Polk TM et al. Complication rates and operative time for endoloop vs endoscopic stapler techniques for laparoscopic appendectomy. J Am Coll Surg. 2015; 4: S66-S67.

3. Kazemier G, Hof KH, Saad S, Bonjer HJ, Sauerland S. Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling? Surg Endosc. 2006; 20: 1473-1476.

4. Vettoretto N, Gobbi S, Corradi A, Belli F, Piccolo D, Pernazza G et al. Consensus conference on laparoscopic appendectomy: development of guidelines. Colorectal Dis. 2011; 13: 748-754.

5. Kagawa Y, Hata S, Shimizu J, Sekimoto M, Mori M. Transumbilical laparoscopic-assisted appendectomy for children and adults. Int J Colorectal Dis. 2012; 27: 411-413.

6. Strzałka M, Matyja M, Rembiasz K. Comparison of the results of laparoscopic appendectomies with application of different techniques for closure of the appendicular stump. World J Emerg Surg. 2016; 11: 4.

7. Meenaskshi R, Fernando D, Szomestein S et al. Staple. 12: 159-161.

8. Kim HO, Yoo CH, Lee SR, Son BH, Park YL, Shin JH et al. Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery. J Korean Surg Soc. 2012; 82: 172-178.