Abstract

Case Report

Laparoscopic approach for acute right iliac fossa pathology: Our experience

Luciano Onofrio* and Gianfausto Iarrobino

Published: 31 December, 2020 | Volume 4 - Issue 2 | Pages: 054-058

Laparoscopic approach in emergency theatre is an irreplaceable tool to manage patients with acute surgical pathology. We retrospectively reviewed surgical access records from the Emergency Department for acute right iliac fossa pathology. We considered 51 patients (16 male, 35 female, mean age 23.8 years) access for acute right iliac fossa pathology over the last year. 44 patients underwent laparoscopic approach (86%); 8 patients were treated with an open approach. Outcomes evaluation was based on data comparison from open appendicectomy over 4 year time period.

Variables considered for data analyses were: role of laparoscopic surgery for gangrenous/perforated appendicitis, Conversion rate, Laparoscopy appendicectomy for elderly patients.

Our study demonstrated that a laparoscopic approach at acute right iliac fossa pathology is feasible, safe and can offer a low incidence of infectious complications, less post-operative pain, rapid recovery, and represent a valid diagnostic tool in doubtful cases, at the expense of longer operating time than OA. We suggest that LA should be the initial choice for all patients with acute right iliac fossa pathology.

Read Full Article HTML DOI: 10.29328/journal.ascr.1001055 Cite this Article Read Full Article PDF

Keywords:

Laparoscopic appendicectomy; Abdominal pain; Right iliac fossa; Complicated appendicectomy

References

  1. Adiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. 1990; 132: 910-925. PubMed: https://pubmed.ncbi.nlm.nih.gov/2239906/ 
  2. Gans SL, Pols MA, Stoker J, Boermeester MA. Expert steering group. Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain. Digest Surg. 2015; 32: 23-31. PubMed: https://pubmed.ncbi.nlm.nih.gov/25659265/ 
  3. Cariati A, Brignole E, Tonelli E, Filippi M, Guasone F, et al. Laparoscopic or open appendectomy. Critical review of the literature and personal experience. G Chir. 2001; 22: 353-357. PubMed: https://pubmed.ncbi.nlm.nih.gov/11816948/
  4. Arias MP, Barreira AS, Sánchez MM, Eire PF, Saavedra SG, et al. Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation. An Pediatr. 2018; 88: 32-38. PubMed: https://pubmed.ncbi.nlm.nih.gov/28254168/
  5. Gans SL, Pols MA, Stoker J, Boermeester MA. Expert steering group. Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg. 2015; 32: 23-31. PubMed: https://pubmed.ncbi.nlm.nih.gov/25659265/  
  6. Onur OE., et al. Follow-up ambulatoriale o “osservazione clinica attiva” in pazienti con dolore addominale aspecifico in pronto soccorso. Uno studio clinico randomizzato. Minerva Chirurgica. 2008; 63: 9-15.
  7. Royds Jones HM. The False "Acute Abdomen". 1951.
  8. Rathish D, Karalliyadda S. Concurrent presentation of thyroid storm and diabetic ketoacidosis: a systematic review of previously reported cases. BMC Endocr Disord. 2019; 19: 49. PubMed: https://pubmed.ncbi.nlm.nih.gov/31101104/
  9. Vetshev PS, Ippolitov LI, KOvalenko EI. False acute abdomen in clinical practice. Klin Med (Mosk). 2003; 81: 20-27.
  10. Ruffolo C, Fiorot A, Pagura G, Antoniutti M, Massani M, et al. Acute appendicitis: What is the gold standard of treatment? World J Gastroenterol. 2013; 19: 8799–8807. PubMed: https://pubmed.ncbi.nlm.nih.gov/24379603/
  11. Lin HF, Lai HS, Lai IR. Laparoscopic treatment of perforated appendicitis. World J Gastroenterol. 2014; 20: 14338–14347. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202363/
  12. Jaschinski T, Mosch CG, Eikermann M, Neugebauer EAM, Sauerland S Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018; 11: CD001546. PubMed: https://pubmed.ncbi.nlm.nih.gov/30484855/
  13. Melanie B, Saltzman DA, Rosen JI, Acton RD, Segura BJ, et al. Standardized irrigation technique reduces intraabdominal abscess after appendectomy. J Pediat Surg. 2019; 54: 728-732. PubMed: https://pubmed.ncbi.nlm.nih.gov/30025605/
  14. Domene CE, Volpe P, Heitor FA. Three port laparoscopic appendectomy technique with low cost and aesthetic advantage. Arq Bras Cir Dig. 2014; 27(Suppl 1): 73–76. PubMed: https://pubmed.ncbi.nlm.nih.gov/25409972/
  15. Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, et al. Laparoscopic Versus Open Appendectomy: Outcomes Comparison Based on a Large Administrative Database. Ann Surg. 2004; 239: 43-52. PubMed: https://pubmed.ncbi.nlm.nih.gov/14685099/
  16. Lim SG, Ahn EJ, Kim SY, Chung Y ll, Park JM, et al. A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis. J Korean Soc Coloproctol. 2011; 27: 293-297. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259425/
  17. Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic appendectomy conversion rates two decades later: an analysis of surgeon and patient-specific factors resulting in open conversion. J Surg Res. 2012; 176: 42-49. PubMed: https://pubmed.ncbi.nlm.nih.gov/21962732/
  18. Wang D, Dong T, Shao Y, Gu T, Xu Y, et al. Laparoscopy versus open appendectomy for elderly patients, a meta-analysis and systematic review. BMC Surgy. 2019; 19: 54.
  19. Kirshtein B, Perry ZH, Mizrahi S, Lantsberg L. Value of laparoscopic appendectomy in the elderly patient. World J Surg. 2009; 33: 918-922. PubMed: https://pubmed.ncbi.nlm.nih.gov/19172345/  
  20. Decadt B, Sussman L, Lewis MP, Secker A, Cohen L,  et al. Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain. Br J Surg. 1999; 86: 1383-1386. PubMed: https://pubmed.ncbi.nlm.nih.gov/10583282/
  21. Viniol A, Keunecke C, Biroga T, Stadje R, Dornieden K, et al. Studies of the symptom abdominal pain--a systematic review and meta-analysis. Fam Pract. 2014; 31: 517–529. PubMed: https://pubmed.ncbi.nlm.nih.gov/24987023/
  22. Sapmaz F, Başyiğit S, Başaran M, Demirci S. Non-Surgical Causes of Acute Abdominal Pain - Actual Problems of Emergency Abdominal Surgery. 2016.
  23. Peedikathara LM, Mandumpala JM, Vallon SM, Kavalakat AJ. Predictors for conversion to open appendicectomy in patients undergoing laparoscopic appendicectomy: a prospective study. Int Surg J. 2018; 5: 2588-2594.
  24. Malý O, Páral J. Appendicitis as a rare cause of mechanical small-bowel obstruction: A literature review of case reports. Int J Surg Case Rep. 2016; 29: 180-184. PubMed: https://pubmed.ncbi.nlm.nih.gov/27865147/
  25. Kothadia JP, Katz S, Ginzburg L. Chronic appendicitis: uncommon cause of chronic abdominal pain. Therap Adv Gastroenterol. 2015; 8: 160–162. PubMed: https://pubmed.ncbi.nlm.nih.gov/25949528/
  26. See TC, Watson CJE, Arends MJ, Ng CS. Atypical appendicitis: the impact of CT and its management. J Med Imaging Radiat Oncol. 2008; 52: 140-147. PubMed: https://pubmed.ncbi.nlm.nih.gov/18373805/

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