Endocoagulator control of the mesoappendix for laparoscopic appendectomy

Laparoscopic appendectomy: quality care and cost-effectiveness for today's economy

BACKGROUND

Open appendectomy (OA) has traditionally been the treatment for acute appendicitis (AA). Beneficial effects of laparoscopic appendectomy (LA) for the treatment of AA are still controversial.

AIM

To present our technique for LA and to determine whether LA should be the technique of choice of any case of AA instead of OA.

MATERIAL AND METHODS

All cases operated for AA (February 2011 through February 2012) by means of LA or OA were prospectively evaluated. Data regarding length of stay, complications, emergency department consultation after discharge or readmission were collected. Patients were classified into four groups depending on the severity of the appendicitis. Economic data were obtained based on the cost of the disposable material. Cost of hospital stay was calculated based on the Ley de Tasas of the Generalitat Valenciana according to the DRG and the length of stay.

RESULTS

One hundred and forty-two cases were included. Ninety-nine patients underwent OA and 43 LA. Average length of stay for LA group was 2,6 days and 3,8 for OA. Average cost of the stay for OA was 1.799 euros and 1.081 euros for LA. Global morbidity rate was 16%, 5% for LA and 20% for OA.

CONCLUSIONS

LA is nowadays the technique of choice for the treatment of AA.

The effects of LigaSure on the laparoscopic management of acute appendicitis: "LigaSure assisted laparoscopic appendectomy"

A very important step in laparoscopic appendectomy is dissection of the appendiceal mesenteric pedicle. The aim of this study was to investigate the effect of LigaSure in laparoscopic appendectomy. Between August 2007 and June 2008, a total of 32 patients were included in the study. Patients were randomized into 2 groups. The first group's dissection of the mesoappendix was performed with LigaSure (5 to 10 mm), whereas the second group's with endodissector and endoclip. The surgical time, postoperative complications, additional analgesics use and hospital stay were compared. There were no significant differences in complication rates, use of analgesics and hospital stay between the groups. The operation time (49.06+/-14.73 min vs. 59.69+/-12.54 min, P=0.036) was significantly lower in the LigaSure group. This study demonstrates that dissection of the mesoappendix with LigaSure reduces the operation time and could be used safely. However, more experiences are needed to attain reliable scientific results.

Laparoscopic appendectomy using the LigaSure Vessel Sealing System

BACKGROUND

Laparoscopic appendectomy is increasingly being employed to treat acute appendicitis. The aim of the present study was to evaluate the efficacy and safety of the LigaSure Vessel Sealing System (Valleylab, Boulder, CO) in laparoscopic appendectomy.

PATIENTS AND METHODS

Laparoscopic appendectomy was performed using the LigaSure system in 15 patients who had a preoperative diagnosis of acute appendicitis.

RESULTS

In two patients, the operation was converted to open appendectomy. The mean operative time was 47 minutes (range, 22-120 minutes). There was no evidence of any complications related to the use of the LigaSure system. Neither surgical endoclips nor an endostapler were used in any patient.

CONCLUSION

Laparoscopic appendectomy using the LigaSure system is a safe and efficient procedure for acute appendicitis. Use of the LigaSure system in laparoscopic appendectomy may simplify the operative procedure and reduce the operative time.

Laparoscopic surgery in children

The surgeon should be aware of the extensive applications of endoscopic surgery in the pediatric patient. The ability to provide surgical care in association with either outpatient or short-stay hospitalizations appear to be cost-effective and appropriate state-of-the-art medical care. Because the array of surgical instruments continues to evolve, new and innovative endoscopic procedures will continue to become increasingly available.

Laparoscopic surgery in girls and female adolescents

The realm of laparoscopic surgery has extended to include the neonate as well as the pediatric patient. The advent of new and smaller instrumentation has facilitated this goal. Previous procedures exclusively relegated to laparotomy can now be accomplished as outpatient procedures. Removal of the acute appendix, correction of torsion of an adnexa, as well as the appropriate diagnosis and initial treatment of acute pelvic inflammatory disease are now well established laparoscopic procedures. This article provides insight into the laparoscopic evaluation and management of a number of challenging clinical problems for the endoscopic surgeon, thus providing a minimally invasive approach for patients ranging from neonates to adults.