Lima Geraldo José de Souza, Silva Alcino Lázaro da, Leite Rodrigo Fabiano Guedes, Abras Gustavo Munayer, Castro Eduardo Godoy, Pires Livio José Suretti
Serviço de Cirurgia Geral e Laparoscópica, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
Arq Bras Cir Dig. 2012 Jan-Mar;25(1):2-8. doi: 10.1590/s0102-67202012000100002.
Acute appendicitis is the most common cause of acute abdominal surgery. Despite nearly three decades comparing laparoscopic with laparotomic appendectomy, the available scientific evidence does not show consensus of opinion about the best access for the treatment of acute appendicitis. The transumbilical laparoscopic assisted appendectomy combines the advantages of laparoscopic access to the simplicity of the laparotomic technique.
To compare the three technical advantages showing possible tendency to transumbilical laparoscopic assisted appendectomy.
This is a retrospective study comparing three series with 1232 patients. Variables were: operative time, hospital stay, early and late postoperative complications, postoperative pain and earlier return to daily activities.
The averaged surgical time was 59.8 min in laparotomic appendectomy, 75.5 min in laparoscopic appendectomy and 51,7 min in transumbilical laparoscopic assisted appendectomy with significant difference. The incidence of postoperative pain, general complications and wound infection were greater in the group submitted to laparotomic appendectomy. The earlier return to daily activities and short hospital stay were observed in groups laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy.
The effectiveness and safety of transumbilical laparoscopic assisted appendectomy can make this technique the preferred choice in the initial management of patients with acute appendicitis.
急性阑尾炎是急性腹部手术最常见的病因。尽管近三十年来一直在比较腹腔镜阑尾切除术和开腹阑尾切除术，但现有科学证据并未就治疗急性阑尾炎的最佳入路达成共识。经脐腹腔镜辅助阑尾切除术结合了腹腔镜入路的优点和开腹技术的简便性。
比较三种技术优势，以显示经脐腹腔镜辅助阑尾切除术可能存在的趋势。
这是一项回顾性研究，比较了三个系列的1232例患者。变量包括：手术时间、住院时间、术后早期和晚期并发症、术后疼痛以及更早恢复日常活动。
开腹阑尾切除术的平均手术时间为59.8分钟，腹腔镜阑尾切除术为75.5分钟，经脐腹腔镜辅助阑尾切除术为51.7分钟，差异有统计学意义。开腹阑尾切除术组的术后疼痛、总体并发症和伤口感染发生率更高。腹腔镜阑尾切除术组和经脐腹腔镜辅助阑尾切除术组更早恢复日常活动且住院时间更短。
经脐腹腔镜辅助阑尾切除术的有效性和安全性可使其成为急性阑尾炎患者初始治疗的首选技术。
