Affiliation:
1. Kazan State Medical Academy, branch of the Further Professional Education Russian Medical Academy of Continuing Professional Education
2. City Clinical Hospital No. 7
3. Kazan State Medical Academy, branch of the Further Professional Education Russian Medical Academy of Continuing Professional Education; City Clinical Hospital No. 7
Abstract
Relevance Treatment of complicated forms of acute destructive appendicitis continues to be an urgent problem in emergency abdominal surgery. Aim of study Improving the results of surgical treatment of patients with appendiceal peritonitis with laparoscopic appendectomy.Material and methods A retrospective analysis of the treatment of 150 patients with acute appendicitis complicated by local and diffuse peritonitis aged from 17 to 69 years was carried out. There were 77 (51.3%) women and 73 (48.7%) men. Depending on the treatment tactics used, two groups of patients were divided. In the main group (64 patients), the leading treatment method was laparoscopic appendectomy. In the comparison group (86 patients), traditional approaches were used, including open appendectomy with the McBurney approach in 72 patients (83.7%) and laparotomy for diffuse peritonitis in 14 (16.4%).Results The analysis of the surgical techniques used showed that in the main group, wound postoperative complications developed in 9 patients (14.1%). In the comparison group, postoperative complications developed in 32 patients (37.2%). For local nonlimited peritonitis, the total duration of hospitalization after laparoscopic appendectomy performed in 49 patients was 6.7±1.4 days, and 8.6±2.1 days (p<0.05) in 72 patients who underwent open appendectomy. The duration of hospitalization was 8.2±2.7 days in case of diffuse peritonitis after laparoscopic appendectomy, sanitation and drainage of the abdominal cavity (15 cases), and 12.4±1.3 days (p<0.05) in 14 patients after laparotomy, appendectomy, sanitation and drainage of the abdominal cavity, intubation of the small intestine.Conclusion Laparoscopic appendectomy may be the operation of choice for complicated forms of acute appendicitis according to developed indications. It should be performed by a surgeon experienced in endosurgical operations. To increase the efficiency of washing the abdominal cavity in case of diffuse peritonitis, it is recommended to use hardware sanitation. The capabilities of laparoscopic appendectomy make it possible to adequately perform the required amount of surgical treatment, minimize surgical trauma, and significantly reduce the rate of postoperative complications and the duration of hospital treatment compared to open appendectomy.
Publisher
The Scientific and Practical Society of Emergency Medicine Physicians
Reference20 articles.
1. Maistrenko NA, Romashchenko PN, Yagin MV. Modern tendencies in diagnostics and treatment of destructive appendicitis. Grekov’s Bulletin of Surgery. 2017;176(3):67–73. (In Russ.) https://doi.org/10.24884/00424625-2017-176-3-67-73
2. Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltrán MA, Biffl WL, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg. 2015;10:35. PMID: 26269709 https://doi.org/10.1186/s13017-015-0032-7
3. Tannoury J, Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol. 2013;19(25):3942–3950. PMID: 23840138 https://doi.org/10.3748/wjg.v19.i25.3942
4. Van den Boom AL, de Wijkerslooth EML, Mauff KAL, Dawson I, van Rossem CC, Toorenvliet BR, et al. Interobserver variability in the classification of appendicitis during laparoscopy. Br J Surg. 2018;105(8):1014–1019. PMID: 29663311 https://doi.org/10.1002/bjs.10837
5. Stoyko YuM, Novik AA, Levchuk AL, Ionova TI, Mamedov VF. Monitoring Parametres Quality of Life at Patients After Traditional and Laparoscopic Appendectomy. Bulletin of Pirogov National Medical & Surgical Center. 2010;5(2):38–43. (In Russ.)