Laparoscopic appendectomy – Our experience

Adrian M Maghiar, MD, PhD, Dan H Ciurtin, MD, PhD, Marius Sfirlea, MD, George E Dejeu, MD, Pravish R Sookha, MD, PhD, Codruta Macovei, MD, Teodor Maghiar, MD, PhD

Spitalul Pelican Oradea, Romania

Aim: Performing the most common of all the surgical operation using the 3 port laparoscopic technique or single port (SILS) technique.

Method: Between October 2008 and September 2011 the surgical teams in our clinic proposed the laparoscopic approach to all patients admitted with acute appendicitis. We had 294 patients with acute appendicitis and 245 agreed to the laparoscopic approach.

Our technique involves us making the first incision just supra-umbilical and using a 5 mm trocar for the 5 mm optics. After performing an exploratory laparoscopy we introduce 2 further trocars, one 5 mm in the left iliac fossa and one 10 mm trocar supra-pubic. We dissect the appendicular artery using the mono-polar cautery, the bipolar cautery or the LigaSure Advance, and use endoloops to close the appendicular stump. We extract the appendix using endobags, using the supra-pubic trocar incision for the extraction.

Results: We attempted laparoscopic appendectomy in all 245 patients that agreed to this, and we performed the operation in 242 of the cases (60 performed by residents), we had 3 conversions to classic surgery due to retro-cecal, sub-serous appendix, which made the dissection using laparoscopy impossible. During 2011 we started using the Dapri curved grasper from Karl Storz and we proposed the SILS approach to 8 patients, 5 agreed and we performed the SILS appendectomy to all of them. We had no major complications. The mean hospital stay was 48 hours +/- 10 hours, and mean surgery duration was 25 min +/- 10 min.

Conclusions: In our experience laparoscopic appendectomy is a very feasible operation, safe and fast in experienced hands, with fast postoperative recovery for the patient, minimal postoperative pain and need for antalgic drugs, excellent cosmetic results. SILS appendectomy is also feasible in very experienced surgeons, but it needs more study before it can be recommended as standard technique.

Session: Poster Presentation

Program Number: P532

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