Page 88 - World Journal of Laparoscopic Surgery

A Safe Scarless Appendectomy
appendectomy decreased the need for additional potentially
“costy” material, like additional ports, endo-loop, and an endo-
bag. The most common reason for conversion in our series was
retrocecal-subserosal appendix with/without a non-mobile
cecum. In cases of generalized peritonitis, we opted directly for
6
a 3-port technique. This attitude was adopted by other authors.
Our impression was that aspiration without a counter-traction was
not sufficient in cases of generalized peritonitis. We could have
used a 2-port technique instead of 3, however, that was not in our
protocol. Localized peritonitis was not a reason for a conversion.
The last advantage is the cosmetics. One month after surgery,
the abdomen was scarless. From here, we felt the importance
of family education about the small but existent risk of intestinal
obstruction later in life. Though our fastest operative time was
short (10 minutes) our mean operative time (40 minutes) was
6
longer than other series. We think that with further experience in
this technique, the operative time might decrease. Regarding the
Fig. 3: The aspect of the abdomen at the 1-month postoperative visit complications, when generalized peritonitis cases were excluded,
we don’t think it’s meaningful to compare the incidence of intra-
it was secondary to morbid obesity and hence difficulty of abdominal infections and digestive complications (like intestinal
extracorporeal ligation of the appendiceal vessels. In 1 patient, perforation) with the conventional 3-port technique as patient’s
it was due to accidental epiploic bleeding. No conversion to population differs. However, wound infection seemed to be the
a laparotomy (or Mcburnery) was needed. Adhesions were main drawback to this technique. In accordance with larger
15
7
encountered during interval appendectomy; however, conversion multiple series, we had 5% umbilical skin superficial infection.
was not needed. Median OT was 50 (10–67) minutes with a mean The reason was probably related to the contact of the infected
of 40 minutes. Intraoperative complications were limited to 1 case appendix with the abdominal wall, although vigorous incisional
of mild epiploic bleeding related to port insertion managed by cleansing was always done before the closure. The installation
bipolar cauterization. No intestinal perforation was encountered. of a protector retractor of Alexis-type might be advantageous in
Median postoperative LOS was 2 days. Two patients (5%) had those cases, however, this was not proven to decrease the risk of
short-term postoperative complications. Both of them had an infections. 16
infra-centimetric umbilical abscess, managed with antiseptic
dressings. No long-term complications were noted. No incisional conclusIon
hernias were found, and no intestinal obstruction was diagnosed.
Esthetic results were very good, with no evidence of a scar at the We had a small population number, so definite conclusions could
month follow of 1 month postoperatively (Fig. 3). not be drawn. Despite this, we feel that the main advantages of
this technique remain: the scarless, easily reproducible, safe, and
low-cost surgery. We think it should be attempted every time a
dIscussIon generalized peritonitis is not suspected.
Although the gold standard technique for appendectomy is
highly debatable, 9,10 there is a growing evidence that laparoscopic suppleMentAry MAterIAl
approach is associated with less postoperative pain, shorter A Supplementary Video to this article is available online on the
LOS, earlier postoperative recovery, less cutaneous infectious website of www.wjols.com.
complications, and better cosmetics. 7,11 The main drawback of
laparoscopic appendectomy was thought to be an increased risk
of postoperative intra-abdominal abscess formation, which was references
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11
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was easy. There was no need to assemble a port; instead a DOI: 10.1016/j.jpedsurg.2007.01.065.
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274 World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022)