[Laparoscopic appendectomy. Surgical technique description and literature review]

Abstract

Introduction: The laparoscopic appendectomy (LA) is considered a surgical process of controversy, although it offers better recovery and better aesthetic results, and allows visualization of the abdominal cavity. In this work, we presented a revision of the topic and the experience of our group in the Endoscopic Surgery Unit at the Dr. Manuel Gea González General Hospital and at the Hospital Médica Sur, both in Mexico City.

Patients and methods: We conducted a retrospective study, randomized, which included patients with LA from January 1, 1993 to December 31, 2002. All were operated on by the same group of surgeons. No exclusion criterion existed for the procedure. The surgical technique used in studied patients is described.

Results: We operated on 218 patients; 69% were women of 10 to 78 years of age with a 27 years-of-age average. Surgical time varied from 20 to 90 min with an average of 35 min. Hospitalization lasted 1 to 5 days, with an average of 2 days. We found peritonitis in 23%. In 202 patients, diagnosis of appendicitis was confirmed; only in 16 patients was diagnosis different. Surgical technique was the same during the entire time. We used the Gea knot with polypropylene to tie off the appendix and appendicular artery. In cases of peritonitis, irrigation was not used, but only aspiration, cleaning with gauzes, and placement of drainages. Mortality was not reported.

Conclusions: LA offers advantages over AA whenever it is carried out by an experienced laparoscopic surgeon. Peritonitis is not a contraindication for LA, and it is not necessary to irrigate with solution for cleaning the peritoneal cavity.