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[Ergonomic and cosmetic aspects of laparoscopic appendectomy: personal technique].

We analyzed our case series in order to evaluate the evolution of our laparoscopic technique in ergonomic and cosmetic terms, leading to the right compromise between these aspects. We retrospectively analyzed 136 diagnostic laparoscopies for suspected appendicitis, using scheme A in the first 98 cases (one 10/12-mm umbilical trocar for the optics and two 5-mm operative trocars placed above the pubis on the right and left side) and scheme B in the other 38 cases (one 10/12-mm umbilical trocar for the optics and two 5-mm operative trocars, one placed over the pubis and the other one on the right hip, just on the umbilical line). The diagnosis of appendicitis was confirmed in 117 patients, while other diseases were present in 19 patients. There were no differences between the two groups in mean operative time (45 min), postoperative complications (0.7%) and clinical course (hospital stay: 36 hours on average). We believe that the right compromise between ergonomic and cosmetic considerations is the one shown in scheme B. In this way it is possible to perform all diagnostic and therapeutic manoeuvres such as pulling the appendix out through the umbilical trocar and using suprapubic trocars as an access route for a possible drainage.

Appendectomy↗
PubMed1992

[Treatment of ligature fistulas after appendectomy].

On the basis of clinical examples, the danger of ambulatory treatment of a ligature fistula is shown. To prevent its development, a care of tissues is necessary: in cases of technical difficulties, a wound should be widened, fat and muscles isolated, a wound before closure needs mandatory irrigation with antiseptic solutions. Ineffectiveness of conservative treatment of a fistula during 1-2 weeks requires the operative intervention in a specialized department with excision of purulent necrotic masses and ligature which maintains the inflammation. Before wound closure, a perforated drain for flowing irrigation should be established.

Adult↗
PubMed1992

[Techniques of appendectomy].

Appendicectomy is a century old. McBurney's incision is the oldest but still most frequently used approach. This well-codified surgical procedure can be made difficult by anatomical variations in the situation of the caecum within the peritoneal cavity or by variations in winding of the appendix around the caecum. In uncomplicated appendicectomy abdominal drainage must be installed only when the base of the appendix is of poor quality. Complicated forms of appendicitis (with peritoneal abscess, appendiceal mass, appendicular peritonitis) have their own specific treatment. Laparoscopic surgery has a role to play among the appendicectomy techniques, and this role seems to be particularly interesting in appendicular peritonitis.

Abscess↗