Laparoscopic appendectomy and minilaparoscopic approach: a retrospective review after 8-years' experience.

BACKGROUND

This is a presentation of our 8-year experience in laparoscopic appendectomy, showing complications and results to determine the advantages and efficacy of laparoscopy.

METHODS

We used this technique from December 1990 to December 1998 on 282 consecutive and non-selected patients (169 females and 113 males) with an average age of 24 years (range 5-86 years). All patients were suffering from sub-acute appendicitis or chronic appendicopathies, except for 84 (29.7%) cases of acute appendicitis and 25 (8.9%) cases of gangrenous appendicitis with peritonitis. All patients with suspected appendicitis were evaluated with a laparoscopic exploration.

RESULTS

In 39 patients (13.9%), appendectomy was performed along with 19 enucleated or endocoagulated ovarian cysts, 8 adhesiolyses, 6 transperitoneal hernioplasties (4 right and 2 left), 2 cholecystectomies, 2 excisions of a Meckel diverticulum, 1 aspiration and suture of a right tubal pregnancy and 1 electrodesiccation of pelvic endometriosis. Thirty-five patients (12.5%) revealed the presence of a gynecological-type pathology. We performed 2 (0.7%) conversions to open exploration and experienced 6 (2.1%) complications, of which only 1 (0.35%) was a major complication: a delayed hemoperitoneum (1 liter), re-operated elsewhere, the cause of which was not identified. We performed 4 (1.4%) relaparoscopies for retrocecal abscess (three patients with primary gangrenous appendicitis and peritonitis presenting with an abscess in the right iliac fossa and in one patient with widespread intestinal adhesions with primary acute appendicitis). No patient with a diagnosis of a normal appendix developed an intraperitoneal abscess. Mortality was non-existent. The postoperative course, which was subjectively better than in cases operated in the traditional way, was, on an average, 2 days (range 1-18 days) for appendectomies carried out with the traditional laparoscopic technique and 1 day for appendectomies carried out with the minilaparoscopic technique (6 patients).

CONCLUSION

We believe that the laparoscopic technique can handle any type of clinical situation, as it can cure several pathologies during the same session with minimal trauma and maximum benefit for the patient. The advantages of a minilaparoscopy approach are based on its low invasiveness and small surgical wounds.