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After appendectomy, mechanical obstruction of the small intestine is often due to local bands. This type of obstruction is classically treated by median laparotomy. We present ten cases of such obstruction treated via the initial gridiron incision, whose advantages are discussed.
Diagnostic laparoscopy is useful in the evaluation of patients with lower right quadrant pain when the diagnosis is uncertain. The object of this study was to determine whether a normal appendix should be routinely removed at laparoscopy. We have decided to do this in children, men under the age of 30 and women of childbearing age. However we do not perform appendectomy in men over the age of 30, women over 50 and in immunodeficient patients. This is a working hypothesis and is the basis of an on-going prospective study in our unit.
Results and complications in 100 patients treated over a 3-year period with the laparoscopic approach for clinically diagnosed acute appendicitis are evaluated. They are compared with results and complications in 100 patients with the same diagnosis who had been treated with the open technique performed by the same surgeon during the same 3 years. The results suggest that laparoscopy provides excellent exposure of the appendix regardless of its position. In the absence of pathology of the appendix, laparoscopy allows for a thorough examination of the entire abdomen and pelvis and good exposure and definitive treatment of most surgical conditions encountered. In the event of appendicitis, regardless of its severity, laparoscopic appendectomy results in less postoperative pain, shorter hospital stays, faster return to normal activities, fewer postoperative complications, and superior cosmetic results. Our experience suggests that the laparoscopic approach is the best approach to diagnosis and treatment of the conditions encountered in patients with suspected appendicitis.
An improved technique for laparoscopic appendectomy based on an experience of > 120 cases is presented. This method includes numerous additions to and modifications of previously described techniques and is effective for gangrenous and perforated appendicitis as well as for less severe cases. The most important elements are that (a) it is a safer procedure for attaining insertion of the Veress needle and the primary trocar; (b) it employs electrocautery to separate the appendix from the mesoappendix; (c) an Endosac can be used for removal of the appendix from the abdomen without contamination of the abdominal wall; (d) no laser is necessary; and (e) staples are rarely necessary.
This paper presents the first recorded combined laparoscopic hysterectomy, appendectomy, and cholecystectomy. The performance of these procedures, in experienced hands, did not alter the outcome. Underlying pathology included uterine myomas, pelvic adhesive disease, and symptomatic gallstones.
We compared two groups of patients with acute appendicitis, from whom the first one had been operated conventionally, the second group by laparoscopy. There was no difference between the two groups regarding length of hospital stay, local and general complications. Only the operating time was quite longer in the laparoscopic group. In our experience laparoscopic appendectomy is an easy and safe procedure which can allow young surgeons to be properly trained in laparoscopic techniques.
Analysis was made of 436 specimens of appendectomy in the Caracas University Hospital during the year 1.990. Ages of the patients ranged between 9 months and 79 years (average age: 21 years). 236 were males and 200 females. The pathology found most frequently was the acute inflammatory processes, followed by secondary reactive changes to other entities, many of which were unspecified (e.g. pelvic inflammatory disease) and other specific (such as infestation by parasites) less frequently were found tumoral processes such as mucocele, carcinoid tumor and those which involved another portion of the digestive apparatus and which secondarily affect the appendix.
The utility of appendectomy performed with laparoscopic procedure is at the present accepted by many surgeons, especially when there is uncertain diagnosis of appendicitis or when an ectopic position is suspected. The authors describe the case report of a 17 years old woman with a diagnosis of subacute appendicitis, in which the unsuccessful finding of the appendix made necessary conversion of traditional laparotomy approach to laparoscopic technique. This choice avoided the execution of an enlargement of laparotomy access, and allowed an easy finding of appendix. Aesthetic results at a distance are very satisfying.
Mycotic aneurysms are a rare complication of septic diseases. Frequently they are recognized only in an advanced stage, with resulting poor prognosis. This case report describes a perforated mycotic abdominal aortic aneurysm following appendectomy. Bacterial culture revealed the presence of streptococcus zooepidemicus, an unusual finding in humans.
During a 13-month period (March 1, 1995 March 31, 1996) the authors performed in 70 children a laparoscopically assisted appendectomy. 68 children were operated on account of chronic appendicitis, two on account of acute appendicitis. During the postoperative period early, not very serious, postoperative complications were recorded in 7 children. One girl had on the second day after operation fever and severe abdominal pain, four children developed on the 5th-7th day after surgery abdominal pain, associated in three instances with fever and in two instances with the pathological finding of pericoecal fluid. The complaints receded within 1-2 days in all five patients after conservative treatment. In another two children the wound healed per secundam intentionem. No late complications were recorded.
An original one-puncture technique of performing laparoscopic appendectomy is described and the implications analyzed. The results of 15 operations are presented, and the advantages and limitations are discussed in the light of current available methods.
A study was undertaken to determine fertility in a group of females who as children had been operated on for appendicitis. The 134 women operated on for appendicitis were reviewed. Their ages ranged from 2-18 years at the time of appendectomy. Our data show that perforated appendicitis before puberty has little if any role in the etiology of tubal infertility.
For the successful management of an emergency appendectomy and abscess drainage in an Eisenmenger's patient with diffuse peritonitis, it may be preferable to use general anesthesia with awake intubation. Epidural anesthesia is commonly combined with this anesthetic management for emergency abdominal surgery. However, the combination of topical anesthesia with epidural anesthesia should be avoided for fear of toxicity of local anesthetics in a patient with complications due to Eisenmenger's syndrome.
An analysis of the diagnosis and operative treatment of 1246 patients with acute appendicitis was used by the authors for considering the causes of groundless appendectomies. The possibilities to reduce the amount of diagnostic errors and improve the surgical strategy for acute simple appendicitis are discussed.
Thirty-six pediatric and adult patients with sickle cell disease (SCD), cholelithiasis, and repeated abdominal crises underwent laparoscopic cholecystectomy (LC) and appendectomy with minimal complications. We prefer using LC to the open method for patients with SCD, and we propose adjustments to the positions of the four trocars to facilitate both procedures without adversely affecting the patient.
From 1.1.1993 to 30.9.1997 1149 patients with right-sided abdominal pain were examined by an experienced sonographer. The specificity of the sonographic diagnosis of acute appendicitis was 98.7%, sensitivity 95.6%, PPV 96.5%, NPV 98.3%, OA 97.8%. The negative laparotomy rate in 1996 was 5.4% (appendix not inflamed by histological examination), perforation rate 11.5%. 25 wrong sonographic diagnoses were made. Out of 530 Patients examined 1995 and 1996 181 alternative diagnoses could be made by ultrasonography. Under not corresponding clinical and sonographic results patients were observed in hospital and clinical and sonographic examination were repeated within 6 hours. Under definite positive sonographic result and questional clinical result operation was preferred. Under recurrent attacks of abdominal pain diagnostic laparoscopy was recommended. Sonographic diagnosis of right sided abdominal pain helped to reduce the risk of restricted indication for diagnostic laparoscopy respectively appendectomy by reducing the number of unnecessary operations without relevant change of perforation rate.
UNLABELLED: In the framework of a prospective clinical trial we wanted to show that minimal access surgery as a standard treatment of acute appendicitis leads to good results. PATIENTS AND METHOD: From January 1993 to December 1996 409 patients had a laparoscopic appendectomy in the Surgical Department of Krankenhaus Zehlendorf, Berlin. We treated 252 female (62%) and 157 male (38%). The mean age was 31.5 years (min. 8 years, max. 81 years) The conversion rate was 8% (33 patients). Reasons for conversion were perforation or difficult anatomical conditions. In 189 patients we found additional diagnosis as adhesions, gynecological diseases or chronic inflammatory bowel diseases. RESULTS: The clinical diagnosis sensitivity histological correlated was 83%. The mean operating time was 46 minutes (min. 10, max. 120 minutes). The basis of appendix was routinely carried by loop of catgut in 342 cases. In 23 cases was used the Endo-GIA. Severe postoperative complications were seen in 2%. In 1.3% planned second-look laparoscopy with drainage was performed. The patients stayed in hospital for 5 days in median (min. 1 day, max. 21 days). The rate of wound infections was decreased specially in fat patients.
The analysis covers 2555 appendectomies, performed on an emergency and scheduled surgery basis in the clinic of emergency surgery.--State University Hospital "Queen Giovanna", Sofia, over the period 1985-1997. Relaparotomy is necessitated in 28 cases (1.09 per cent) because of various postoperative complications. Data are presented on the number of relaparotomies, done under conditions of emergency and scheduled surgery, and with a special reference to the pathoanatomical character of appendicitis. The underlying causes of undertaking relaparotomy and postoperative lethality are analyzed. As shown by the obtained results post-relaparotomy mortality rate is the highest after primary operation for destructive form of appendicitis and advanced form of peritonitis.