Cirugía laparoscópicaVía de abordaje de elección en el tratamiento de apendicitis aguda

Abstract

OBJECTIVE To establish the reliability and advantages of laparoscopic appendectomy. MATERIAL AND METHOD We are studied 2132 laparoscopic appendectomies (1237 women y895 men). Mean age 26,47±15,12 years. Clinical diagnosis by historiy, physical examination, and leukocyte count formula and plain radiograph. Conversion criteria: generalized peritonitis and plastrons highly evolved, multiple adhesions, lack of experience to solve other associated diseases and carry more than 30 minutes without observing operating progress. Operation is carried out by a surgeon assisted by a nurse. Pneumoperitoneum with Veress needle. Three entrances. Appendicular meso treatment is done by monopolar electrocoagulation and the appendicular base through EndoGIA. The workpiece is removed through the 12 mm trocar sheath or by pouch. Drainage unsystematic. RESULTS Conversions: 2,8% (N= 60) due to generalized peritonitis and plastrons. Diagnostic errors : 5,6% (N=120). Complications excluding conversions: 1,735% (N=36), as Wall abscess (N=10), deep abscess (N= 4), paralytic ileus (N=2), hemoperitoneum (N=1). There was only one reoperation and was in the case of hemoperitoneum. Mean operating time: 32,68±18,08 minutes. Hospital days: 2,92±1,95. Intestinal Transit Recovery Time: 19,71±11,84 hours. Time to regain regular physical activity: 7,97±3,83 days. Analgesia hours: 79,9% required less than 24 h, 16,29% between 24-48 h. Only 3,85% need more than 48h. CONCLUSION Laparoscopic appendectomy is safe, easily reproducible and has few complications when we use a rigorous and systematic technique. For us it the treatment of choice for acute apendicitis.