Morbidity of laparoscopic surgery for complicated appendicitis: an international study.

BACKGROUND: Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. METHODS: A retrospective review of complicated appendicitis managed surgically by eight surgical groups from six countries was undertaken. Among 3,433 patients with appendicitis, 1,017 (29.5%) had complicated appendicitis, which included perforated or gangrenous appendicitis with or without localized or disseminated peritonitis. There were 74 preoperative abscesses (7.4%) and 5 small bowel obstructions. RESULTS: One patient died. There were 29 postoperative intraabdominal abscesses (2.8%) and 112 mostly minor complications. Conversion to laparotomy was necessary for 28 patients (2.7%). The surgical time ranged from 32 to 132 min (mean, 62 min), and the hospital stay ranged from 1 to 18 days (mean, 3.5 days). CONCLUSIONS: The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.

Laparoscopic diagnosis and treatment of an acute epiploic appendagitis with torsion and necrosis causing an acute abdomen.

Acute epiploic appendagitis is not as rare as previously thought; but, since the presenting signs and symptoms are not specific, preoperative diagnosis has been rarely made. At the present time, a laparoscopic exploration of the peritoneal cavity will establish the correct diagnosis, and the treatment can be provided during the same procedure. Herein, a case of a 63-year-old female patient with acute abdominal syndrome caused by a necrotic epiploic appendix that was successfully diagnosed and treated laparoscopically is described. A review of the literature is made, as well.

Technical modifications for laparoscopic appendetomy and other pelvic procedures using microinstruments.

Reusable microinstruments are used in a modification of the three-port technique for laparoscopic appendectomy and other pelvic procedures; the method is described herein. Fifty-seven consecutive patients were operated upon using this technique. There was no mortality; there were two minor complications and no conversions to laparotomy. Pain medication needs were minimal in all patients, and the cosmetic results were excellent. The use of microinstruments for pelvic laparoscopic procedures is safe and cost-effective using the technical modifications described.

Laparoscopic management of spermatic cord entrapment after laparoscopic inguinal herniorrhaphy.

Spermatic cord entrapment is an unusual complication of inguinal herniorrhaphy. The case of a 52-year-old man who presented with severe pain along the left spermatic cord and testicle, varicocele, and dyspareunia after a laparoscopic bilateral inguinal hernia repair performed elsewhere is reported. Medical treatment failed, and laparoscopic exploration showed the vas deferens and spermatic vessels entrapped by a mesh slit that was pulling the genital branch of the genitofemoral nerve. The vas deferens and spermatic vessels were released, neurotomy of the affected nerve branch was performed, and a new mesh was positioned in the residual space. The patient's pain disappeared completely after the surgery and the varicocele decreased progressively. The patient remains asymptomatic at 1-year follow-up. Laparoscopy might be the approach of choice to treat some of the complications of laparoscopic hernia repair, not only because it allows better observation of the anatomic structures, but also because the surgical therapy can be done with minimal tissue damage compared to the traditional approach.

[Usefulness of the trans-umbilical incision in laparoscopic surgery]. / La utilidad de la cicatriz umbilical en la cirugía laparoscópica.

Most surgeons induces pneumoperitoneum with the Verres' needle via an infra or a supraumbilical route; only a reduced group does it true the umbilicus. This paper reports the authors experience using the trans-umbilical route emphasizing its differences and advantages over the conventional umbilical approach. The files of our last 100 laparoscopic cholecystectomies performed in different hospitals were reviewed. Trans-umbilical route was used in 93 cases. Four patients were found to have an umbilical hernia with no content in its sac and it did not compromised the approach. In 7 cases the semi-open technique had to be used because of previous abdominal surgery. There were no major complications during the induction of the pneumoperitoneoum; no hematomas infections or post-operative umbilical hernias either, just a mild pneumopreperitoneum occurred in 5 patients. Trans-umbilical approach for pneumoperitoneum induction is useful, safe, easy to repair, has a low infection rate, and provide better cosmetic results; scar is almost invisible deep in the umbilicus. This approach has several advantages over the ordinary umbilical approaches by been cautious and by using the authors' technique, mini-invasive procedures can be initiated quick and safely.