The "BASE-FIRST" technique in laparoscopic appendectomy

Abstract

Background: Appendicitis is the most common cause of acute abdomen, and appendectomy is the most frequent surgical procedure performed in the world. In recent times, laparoscopic appendectomy has been gaining increasing consensus, although comparison with traditional open surgery is still debated. Recent reports seem to agree in recognizing laparoscopy as the favourable approach in cases of non-complicated appendicitis, in women and in obese patients. The use of a linear stapler to close the appendiceal stump also seems to guarantee a dramatic decrease of complications and this observation could be the rationale for considering the laparoscopic approach to also be safe in complicated appendicitis. In these cases, dissection of the mesoappendix and isolation of the viscum could be very difficult and could cause complications. By proposing this technique using a laparoscopic approach, we try to permit a simple and safe section of the appendix leaving the detachment from vessels and from the neighbourhood to a second moment.

Materials and methods: We report our initial experience including the first 50 cases and proposing our personal technique of laparoscopic appendectomy.

Results and conclusion: We recorded only one intraoperative haemorrhage, one bladder perforation due to trocar insertion and no conversion. Our goal is to standardize and simplify the laparoscopic approach in order to give any surgeon, even non-expert ones, a simple way to remove the viscum especially in complicated pictures.

Keywords: Appendicitis; endoscopic stapler; laparoscopy.

Figure 1

Avascular space between the caecum, the appendix and the mesoappendix

Figure 2

Appendix is sectioned firstly with ATW 35

Figure 3

A second white cartridge is used to cut the meso-appendix