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PubMedDate not supplied

[Laparoscopic appendectomy. Surgical technique description and literature review].

INTRODUCTION: The laparoscopic appendectomy (LA) is considered a surgical process of controversy, although it offers better recovery and better aesthetic results, and allows visualization of the abdominal cavity. In this work, we presented a revision of the topic and the experience of our group in the Endoscopic Surgery Unit at the Dr. Manuel Gea González General Hospital and at the Hospital Médica Sur, both in Mexico City. PATIENTS AND METHODS: We conducted a retrospective study, randomized, which included patients with LA from January 1, 1993 to December 31, 2002. All were operated on by the same group of surgeons. No exclusion criterion existed for the procedure. The surgical technique used in studied patients is described. RESULTS: We operated on 218 patients; 69% were women of 10 to 78 years of age with a 27 years-of-age average. Surgical time varied from 20 to 90 min with an average of 35 min. Hospitalization lasted 1 to 5 days, with an average of 2 days. We found peritonitis in 23%. In 202 patients, diagnosis of appendicitis was confirmed; only in 16 patients was diagnosis different. Surgical technique was the same during the entire time. We used the Gea knot with polypropylene to tie off the appendix and appendicular artery. In cases of peritonitis, irrigation was not used, but only aspiration, cleaning with gauzes, and placement of drainages. Mortality was not reported. CONCLUSIONS: LA offers advantages over AA whenever it is carried out by an experienced laparoscopic surgeon. Peritonitis is not a contraindication for LA, and it is not necessary to irrigate with solution for cleaning the peritoneal cavity.

Adolescent↗
PubMed2004

Intrathecal fentanyl in spinal anesthesia for appendectomy.

OBJECTIVE: The authors assessed the effectiveness of the administration of fentanyl in spinal anesthesia for appendectomy. MATERIAL AND METHOD: Forty patients randomized double-blind, were recruited to receive either 4 ml of 0.5% hyperbaric bupivacaine + 20 mg of fentanyl (Group F) or 4 ml of 0.5% hyperbaric bupivacaine 0.5% + 0.4 ml normal saline (Group S). RESULTS: There were no significant differences in the highest analgesic level between the groups. The number of segments regressed at 60 min in Group F was statistically less than in Group S (0 vs. 2; P 0.002). Group F showed significantly lower median VNS pain scores than Group S (0 vs. 3; P 0.004). Time to first required postoperative analgesics in Group F was significantly higher than in Group S (13.6 vs. 6.3 h, P < 0.001). The incidence of shivering in Group F was significantly lower than Group S (35% vs. 70%; P 0.023). There were no significant differences in the incidence of nausea, vomiting, hypotension and urinary retention. No patient developed respiratory depression or PDPH. The patients' satisfaction of spinal anesthesia was 100% in Group F and 80% in Group S. CONCLUSION: Intrathecal 20 microg fentanyl significantly improved the quality of analgesia, it prolonged the duration of bupivacaine in spinal anesthesia and delayed the analgesics requirement in the early postoperative period. Shivering was less frequently found in the fentanyl group.

Adjuvants, Anesthesia↗
PubMed2004

[Prophylactics and treatment of pyo-inflammatory complications after appendectomy].

The developed method of prophylactics and treatment of pyo-inflammatory complications in the wound after operation of appendectomy with the help of mid-frequency ultrasound with dioxidin as phonophoresis allows to make suppurations in the postoperative patients 5.15 times rarer and the number of pyo-inflammatory complications 6.68 times rarer. The time of healing the wounds was 1.2+/-0.3 days shorter and the duration of treatment of such patients in the hospital 1.8+/-0.8 days less.

Abdominal Abscess↗
PubMed1992

[Questionable appendectomies].

Each year in France, 75,000 appendectomies are carried out for normal or fibrous appendix and another 75,000 for a mere inflammation of the mucosa of submucosa. To decrease the incidence--four times higher than in other countries--it is suggested to keep under observation the patient with RIQ tenderness if they have neither rebound nor guarding, a temperature below or equal to 38 degrees C and a white blood cell count lower than 10,000/mm3. By following these guidelines, there is no risk to miss perforated or suppurated appendicitis.

Abdomen, Acute↗
PubMed2005

Clipping of the appendix induced cardiac arrest during appendectomy under spinal anesthesia.

Bradycardia is commonly seen in high spinal anesthesia, however, evolution of cardiac arrest from sudden onset of severe bradycardia is infrequent. Prompt recognization and resuscitative measures are of paramount importance because they may insure a complete recovery without sequela as an aftermath. We report herein a case of severe sinus bradycardia induced by clipping of the appendix during appendectomy under spinal anesthesia with the sensory block up to T5 dermatome. Prompt intravenous atropine failed to regain normal sinus rhythm, and cardiac arrest ensued. Cardiac massage, manual ventilation with oxygen and low-dose epinephrine successfully resuscitated the patient. The possible mechanisms and management of this complication are also discussed.

Anesthesia, Spinal↗
PubMed2005

[Intestinal microvessels in patients of different ages after an appendectomy].

The numbers and diameters of microcirculatory bed vessels located in the wall of various regions of small and large intestine, were determined in 43 patients of lirst and second mature ages and in 19 aged and senile patients less than one year - more than ten years after an appendectomy. In was established that during the first year following the operation, the number of arterioles, capillaries and venules per standard area of the section in middle-aged patients was increased in the wall of caecum and ileo-caecal transition with a concomitant increase in the lumen of these vessels. These changes were most pronounced in capillaries, while arterioles were less affected. Vascular changes were expressed in the wall of caecum close to post-operational scar and in the wall of ileo-caecal transition, but in the wall of middle part of small intestine and middle part of colon transversum they disappeared. Three years following the operation, the numbers of microcirculatory bed vessels and their luminal diameters were similar to those found in people with an intact appendix. The changes described were not detected in aged and senile persons.

Adult↗
PubMed2006

Perioperative management of a patient with Henoch-Schonlein purpura for appendectomy.

Henoch-Schonlein purpura HSP is a multisystem disease and immunoglobulin A-mediated vasculitis with a self-limited course affecting the skin, joints, gastrointestinal tract, and kidneys. It is the most common form of acute small-vessel vasculitis primarily affecting children. Severe renal and central nervous system disease may lead to life-threatening conditions, and immunosuppressive agents and plasmapheresis may be needed. The cause of HSP is unknown; immunizations, certain food allergies, insect bites, infection, and some medications may play a role in the development of the disease. Perioperative management for liver and kidney functions is very important for anesthetized patients with HSP. We report the perioperative management of a patient with HSP for appendectomy.

Appendectomy↗
PubMed1991

[Causes of suppurative complications after appendectomy].

The causes of purulent complications in 9,518 patients after appendectomy were studied. The total percentage of purulent complications was 8.0 (6.4 among males and 10.1 among females). It is shown that the form of appendicitis (phlegmonous in 2.0% of males and in 2.0% of females and perforating in 17.7% and 44.9%, respectively) and the time from the onset of the disease to the operation (less than 6 hours in 4.0% of males and in 6.1% of females; more than 48 hours in 11.7% and 18.8%, respectively) have an effect on the frequency of purulent complications. The authors revealed a correlation between the frequency of purulent complications and some factors (the time spent by the patients in the clinic before the operation, surgical team with an incomplete staff, insufficient anesthesia, insufficient operative approach, irrational use of gauze tampons and antibiotics.

Adult↗
PubMedDate not supplied

[Appendectomy with intraoperative celioscopy in children. 465 cases].

The authors report a retrospective series of 465 appendectomies with intraoperative celioscopy in children under age 16. The technical issues and the indications are discussed. The results are the following: No death, 3.6% intraoperative incidents of no consequence, 3% postoperative complications, including 1.3% requiring second surgery or celioscopy. These results are better than those obtained with conventional surgery. The advantages of appendicectomy with intraoperative celioscopy are the following: easy, quick search for the appendix, whatever its location, exploration of the entire abdominal cavity, possibility to perform a complete peritoneal washing, suppression of parietal complications, and almost no skin scar, definite reduction in the number of intraperitoneal residual abscesses, and likely reduction of postoperative adhesions, which are a cause of obstruction, of chronic pain and of infertility in girls, rapid resumption of transit and of all activities, including sports.

Adolescent↗
PubMed1991

[Use of preventive intra-operative antibiotic administration in appendectomy. A pharmacokinetic study].

Studies on Cefazedone-kinetics in serum and subcutaneous fat tissue showed an early and lasting tissue concentration high above minimal inhibitation concentrations so that intraoperative single-shot administration of antibiotics are proven to be effective. Due to these pharmacokinetic patterns the results of an earlier prospective trial is confirmed that single-shot antibiotics during surgery are useful to reduce postoperative wound sepsis rate after appendectomy.

Adipose Tissue↗
PubMed1991

Simultaneous appendectomy and inguinal herniorrhaphy could be beneficial.

Two patients seen in Murtala Muhammed Hospital in Kano, Nigeria in 1989, who developed acute appendicitis after inguinal hernia repair during which the appendices were present in the hernia sacs but not removed, are described. Eleven patients who had an appendectomy during inguinal hernia repair are also described. None had a wound infection or recurrence of their hernia. Because of the possibility that postoperative adhesions in the vicinity of the appendix might subsequently provoke inflammation, it is suggested that an adequately exposed appendix in an inguinal hernia sac be routinely removed.

Acute Disease↗
PubMed1991

[Evaluating histologic findings after appendectomy].

The results of the histopathologic examination of 262 appendices after incidental appendectomy were reviewed. Only 17.5% of the histologies were regarded as normal. Fibrosis, obliteration and chronic appendicitis were described frequently. It is discussed whether these findings belong only to the normal histologic appearance of appendices in more advanced age.

Abdomen, Acute↗
PubMed1991

[Conservative treatment of post-appendectomy abscesses].

The standard form of treatment for an abscess in the abdominal cavity is surgical drainage. We present a prospective study of 626 patients under the age of ten who underwent appendectomy. The antibiotic prophylaxis consists of cefoxitin and ampicillin. Postoperative intra-abdominal abscess were found in 1.4% of the patients who were then treated with antibiotics (metronidazole plus amicacin). Following this course of treatment, of the nine abscess, 4 required no surgical drainage, and progressed favourably as shown by the clinical controls and ultrasonography (US). In 3 patients, percutaneous drainage was performed and controlled by US. This paper shows that antibiotic therapy is a useful alternative in the treatment of postappendectomy intraabdominal abscess.

Abdomen↗
PubMed1990

[Risk factors of wound suppuration after appendectomy].

The effect of some factors on the development of wound suppuration was studied in prospective examinations including 241 operations for destructive appendicitis. It was found that the presence of exudate, monoantibacterial prophylaxis, and the method of wound closure had no essential effect on the proportion of suppurations. The determinant factor is the surgeon's qualification, not his experience in general, but his experience in appendectomy in particular and individual technical traits.

Appendectomy↗
PubMed1989

[Is the search for Meckel's diverticulum in appendectomy still a current problem in common surgical practice?].

During a ten year period from 1978 to 1988, 46 Meckel's diverticula (MD) were removed from patients with clinical symptoms of appendicitis. These were detected incidentally among 3230 appendectomies which were routinely followed by small bowel exploration. Only 45.6% had histopathologically inconspicuous diverticular mucosa. 17.4% of MD displayed pathological mucosal changes in the face of a normal appendix. In 10 patients both conditions co-existed. There were no postoperative deaths. Postoperative complications requiring operative revision occurred in one patient. The search for a MD should be routine, and not only consequence of finding a normal appendix. The rationale for the routine removal of a MD is not only its role as a potential risk factor and the lesser operative risk, but the fact that a macroscopically bland diverticulum reveals histopathological abnormalities considerably more often than commonly assumed.

Adult↗
PubMedDate not supplied

[Umbilical hernia and appendectomy].

Results of 334 appendectomies carried out through the umbilical orifice are reviewed. Failures of treatment and complications of the method are reported while emphasizing that only 4 major complications occurred. When compared with the classical incision of right iliac fossa this procedure does not appear to provoke more risks and presents obvious esthetic advantages.

Abscess↗
PubMed1987

[Indications for appendectomy. A retrospective analysis].

This retrospective study was conducted into 1.506 patients who had been admitted to the author's hospital for suspicion of acute appendicitis, between 1971 and 1979. Indications for appendectomy were handled with generosity, and primary laparotomy was applied to 44.2 per cent of all cases. Perforated appendicitis was of low incidence, accounting for only three per cent, while no acute inflammatory lesions were recordable at all from 36 per cent of removed appendices. Follow-up checks were made on all patients who had not been operated on, in the first place, not later than five years from first diagnosis. Only 15 per cent of these patients had to be eventually appendectomised. For them distribution of histological diagnoses was similar to that of patients with surgery as primary approach. Recurrence of pain was reported by one third of patients without surgery. However, only 14.9 per cent of them saw a doctor on their problem, and only 3.7 per cent had to be rehospitalised. Primary wait-and-see attitude caused no further increase in the incidence of perforated appendicitis.

Adolescent↗
PubMed1986

[Indications for appendectomy].

While the statistical morbidity and mortality rates of appendicitis are high in the GDR, a declining trend has been recordable since 1970. The incidence of appendicitis in the GDR, as compared to figures in other countries, has supported the author's insistence on early indication and surgical action to prevent the occurrence of avoidable deaths. This is the reason why a liberal approach is taken to appendectomy in cases of appendicitis.

Appendectomy↗