Considerations regarding laparoscopic appendectomy] Jurnalul

The aim of this work is to support, using our own personal experience, the laparoscopic approach for appendectomy. Methods: We retrospectively analyzed a series of 93 consecutive cases oflaparoscopic appendectomy for acute appendicitis, performed between 1/01/1997 and 1/01/2011 in the Department of General Surgery – “Agrippa Ionescu” Clinical Emergency Hospital,Bucharest. Results: There were 71 women and 22 men in our series. Mean age of the patients was 36,8 years. 88 cases were finalized by laparoscopic approach. Indications included all stages of acute appendicitis: catharal (56 cases), phlegmonous (19 cases), gangrenous (14 cases) and even perforated appendix with generalized peritonitis (4 cases). The rate of conversion to open surgery was 5,38% (5 cases), mostly due to the lack of experience in the first years of using this approach.Three techniques of appendectomy were used: anterograde, retrograde and stapled. The mean duration of hospitalization was 2.7 days. Postoperative evolution was uneventful for all cases,except one case of parietal hemorrhage from the suprapubic working trocar-site which was solved by laparoscopic reintervention. Conclusions: Laparoscopic approach is gold standard in diagnosis and treatment of acute appendicitis and right iliac fossa pain syndrome, especially for fertile women. This method allows also a good exploration of entire abdominal cavity, thus being possible the diagnosis and surgical treatment of synchronous surgical pathology, identification of appendix more facile than open approach and another advantages of minimally invasive approach.