Applying of Endovideosurgical Technology in Treatment of Acute Appendicitis

A.M. Khadjibayev, F.B. Alimdjanov, U.R. Aripov

Abstract


There is no controversy in choosing of approach at laparoscopic appendectomy (LA), but the issues of preparation ways of the base, mucous of the appendix still remain discussable and require a further investigation.
A new of appendix preparation at LA has been worked-out and implemented in our hospital (patent № IAP 04519). The reliability of an offered method has been proved by an experience of performing more than 500 laparoscopic appendectomies.
The aim of research is improvement of treatment outcomes for the patients with acute appendicitis based on the use of endovideoscopic technologies using new ways of appendix preparation.
We investigated treatment outcomes of 544 patients underwent appendectomy with the use of endovideosurgical technique from 2007 to 2012.
The method of LA is standard and consists of 3 laparoports. There were 37.6 % men and 62.4 % women. According to the preparation ways of appendix at LA patients were divided into 3 groups: the 1st one is ligature way with the use of Reoder’s extracorporal node — 83 (15.2 %) patients; the 2nd group — using Reoder’s endoligature and clipping an appendix base — 168 (30.9 %) cases; the 3rd one is preparation of appendix base according to the method of RRCEM — 293 (53.9 %) patients. Due to the nature of inflammatory alterations: congestive appendicitis — 74 (13.6 %), phlegmonous appendicitis — 423 (77.8 %) and in 47 (8.6 %) cases — gangrenous appendicitis.
Our preparation way is based on appendix mobilization from mesentery, ligation at the appendix base, ring-shaped dissection of seromuscular level of mobilized appendix 7–8 mm upper from ligation, displacement of the formed seromuscular clutch towards to ligatures, dissection of mucous and submucous levels of appendix. After dissection of mucous and submucous levels of appendix the formed seromuscular clutch is expanded and it covers appendiceal stump is clipped with titanic clip. The technique of ligature way of appendiceal stump provides a required removal of mucous membrane from stump with the use of monopolar electric coagulation.
It is determinate that a duration of LA at using ligature way with monopolar coagulation of mucous membrane of stump was 51.6 ± 0.9 minutes, at using RRCEM method it increased till 60.5 ± 1.9 minutes and it was stipulate by the technical peculiarities of operation. The 1st and the 2nd groups had 15 (5.9 %) complications in early post-operative period, in the 2nd one — 4 (1.3 %) and there were no statistical differences. Infiltrates in abdominal cavity were more often developed in 1st and 2nd patients groups n = 12 (4.7 %) in compare with the control one n = 4 (1.3 %) (p ≤ 0.05). Abdominal cavity abscesses have been developed in 2 patients (0.79 %) of the 1st group. 1 patient from the 1st group (0.3 %) had appendix stump failure.
So, the use of new way of appendix stump preparation at LA allows 4-fold reduction in the quantity of early post-operative complications and makes up 1.3 %. Applying the method of stump covering by RRCEM method eliminates electric impact on tissues of head of blind colon and probability of electrical injury and thereby the risk of appearance of appendix stump failure is reduced, covering of stump mucous membrane decreases the probability of developing of stump abscess.


Keywords


acute appendicitis; laparoscopic appendectomy; appendiceal stump

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DOI: https://doi.org/10.22141/1997-2938.2.21.2013.87519

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