Re-laparoscopy for the treatment of complications after laparoscopic appendectomy: is it possible to maintain the minima
- PDF / 421,202 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 19 Downloads / 176 Views
ORIGINAL ARTICLE
Re‑laparoscopy for the treatment of complications after laparoscopic appendectomy: is it possible to maintain the minimally invasive approach? María A. Casas1 · Francisco Laxague1 · Francisco Schlottmann1 · Emmanuel Ezequiel Sadava1 Received: 8 July 2020 / Accepted: 26 October 2020 © Italian Society of Surgery (SIC) 2020
Abstract Despite laparoscopy is considered an adequate tool for the diagnosis and management of postoperative surgical complications, its role after laparoscopic appendectomy (LA) remains uncertain. The aim of this study was to evaluate whether laparoscopy is useful for treating complications after laparoscopic appendectomy. A retrospective analysis of a prospectively collected database of patients undergoing LA, who needed a reoperation for postoperative complications during the period 2006–2020, was performed. Demographics, operative variables, and postoperative outcomes were analyzed. A total of 2019 LA were performed, and 41 patients (2%) underwent a RL for post appendectomy complications. Twenty-three patients (56%) were male. The mean age was 32 years old (16–92 years). The majority of patients (75%) had a complicated acute appendicitis in the first operation. The most common findings at RL were generalized peritonitis (36.4%) and intraabdominal abscesses (26.8%). Five patients (12.1%) developed stump appendicitis, all of them as a late complication. The procedures were completed laparoscopically in 85% and 6 patients (15%) required conversion to an open approach. Three patients (7.3%) required a percutaneous drainage and two patients (4.9%) needed an additional surgery (laparotomy) after RL, all of them presenting with generalized peritonitis at the RL. No mortality was registered. Re-laparoscopy is feasible, safe, and highly effective for the diagnosis and treatment of post appendectomy complications. RL should be encouraged to avoid more aggressive procedures. Keywords Relaparoscopy · Laparoscopic appendectomy · Intraabdominal infections · Laparoscopy
Introduction Acute appendicitis (AA) is one of the most common surgical emergencies worldwide [1]. In the United States, there is an overall incidence of approximately 9 cases per 10,000 population per year, and an overall lifetime risk of 15% [2]. Laparoscopic appendectomy (LA) has become the standard treatment for AA due to shorter recovery time, length of hospital stay, and reduced wound infection rates as compared to the open approach [3]. The role of re-laparoscopy (RL) for the treatment of complications following LA is still not well elucidated. The
risk of inadvertent injury due to bowel distention, the fear of incomplete exploration of the abdominal cavity, and the hypothesis that infected contents may spread through the abdominal cavity with the pneumoperitoneum, are common reasons for surgeons to use a laparotomy to deal with postoperative complications [4, 5]. Although multiple studies have supported the use of laparoscopy for the management of postoperative complications after abdominal surgery [6–9],
Data Loading...
