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Laparoscopy Diagnostic applications in suspected appendicitis and access-related complications

Moberg, Ann-Cathrin LU (2005)
Abstract
Laparoscopic surgery was introduced to minimize patient trauma. However, fatal technique specific complications, due to major vascular or visceral injury, were at times seen related to blind abdominal access using the Veress technique.



A modified open access technique was developed and evaluated in 100 patients and found to be fast and easy to learn with few associated complications. This open technique was compared retrospectively to the Veress technique in 4363 patients after extensive educational efforts in optimizing both techniques were made. No major vascular and only five visceral injuries were seen with no difference between the groups.



The diagnostic accuracy in patients operated due to... (More)
Laparoscopic surgery was introduced to minimize patient trauma. However, fatal technique specific complications, due to major vascular or visceral injury, were at times seen related to blind abdominal access using the Veress technique.



A modified open access technique was developed and evaluated in 100 patients and found to be fast and easy to learn with few associated complications. This open technique was compared retrospectively to the Veress technique in 4363 patients after extensive educational efforts in optimizing both techniques were made. No major vascular and only five visceral injuries were seen with no difference between the groups.



The diagnostic accuracy in patients operated due to suspected appendicitis varies between 60-90% depending on patient gender and age. The complication rate when having a healthy appendix removed is approximately 10 %. Laparoscopy was introduced for diagnostic purposes and a macroscopically normal appendix was left in place. Substantial educational efforts were made in developing teams for 24-hours-a-day service. In a study of 500 consecutive patients, we succeeded in performing a diagnostic laparoscopy (DL) in 75%, leaving 66 patients with their appendices left in place. No complications were seen in the DL group and no appendicitis was missed. In a multi-centre study of 1043 DL in suspected appendicitis 211 patients had a DL as a single procedure with a complication rate of 2% and no missed appendicitis.



No randomized study comparing open and laparoscopic appendectomy has been performed in patients with confirmed appendicitis. Recovery after laparoscopic and open appendectomy was compared in 163 patients randomized after appendicitis was confirmed at DL when both techniques were applicable and the learning curve was passed. There was no significant difference in time to full recovery between the groups. However, a trend towards faster recovery was noted in the laparoscopic appendectomy group.



In summary, the modified open access technique is recommended for safety reasons. It is fast, easy to learn and applicable in most patients. DL is safe and accurate for diagnosis and can be recommended in patients with suspected appendicitis. A macroscopically appearing appendix can be left in place. There is no difference in time to full recovery between open and laparoscopic appendectomy in appendicitis confirmed at DL. Choice of method for appendectomy depends on surgeon preference. (Less)
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author
supervisor
opponent
  • Docent Rudberg, Claes
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Surgery, orthopaedics, complications, laparoscopy, diagnostic laparoscopy, ortopedi, traumatologi, traumatology, Kirurgi
pages
107 pages
publisher
Department of Surgery, Malmö University Hospital, Lund University
defense location
Lecture room at the surgical department University Hospital of Malmö
defense date
2005-01-14 09:15
ISBN
91-628-6322-3
language
English
LU publication?
yes
id
d32e28f1-74ac-4b79-8093-2f471afa822c (old id 544210)
date added to LUP
2007-09-23 10:56:47
date last changed
2016-09-19 08:45:07
@misc{d32e28f1-74ac-4b79-8093-2f471afa822c,
  abstract     = {Laparoscopic surgery was introduced to minimize patient trauma. However, fatal technique specific complications, due to major vascular or visceral injury, were at times seen related to blind abdominal access using the Veress technique.<br/><br>
<br/><br>
A modified open access technique was developed and evaluated in 100 patients and found to be fast and easy to learn with few associated complications. This open technique was compared retrospectively to the Veress technique in 4363 patients after extensive educational efforts in optimizing both techniques were made. No major vascular and only five visceral injuries were seen with no difference between the groups.<br/><br>
<br/><br>
The diagnostic accuracy in patients operated due to suspected appendicitis varies between 60-90% depending on patient gender and age. The complication rate when having a healthy appendix removed is approximately 10 %. Laparoscopy was introduced for diagnostic purposes and a macroscopically normal appendix was left in place. Substantial educational efforts were made in developing teams for 24-hours-a-day service. In a study of 500 consecutive patients, we succeeded in performing a diagnostic laparoscopy (DL) in 75%, leaving 66 patients with their appendices left in place. No complications were seen in the DL group and no appendicitis was missed. In a multi-centre study of 1043 DL in suspected appendicitis 211 patients had a DL as a single procedure with a complication rate of 2% and no missed appendicitis.<br/><br>
<br/><br>
No randomized study comparing open and laparoscopic appendectomy has been performed in patients with confirmed appendicitis. Recovery after laparoscopic and open appendectomy was compared in 163 patients randomized after appendicitis was confirmed at DL when both techniques were applicable and the learning curve was passed. There was no significant difference in time to full recovery between the groups. However, a trend towards faster recovery was noted in the laparoscopic appendectomy group.<br/><br>
<br/><br>
In summary, the modified open access technique is recommended for safety reasons. It is fast, easy to learn and applicable in most patients. DL is safe and accurate for diagnosis and can be recommended in patients with suspected appendicitis. A macroscopically appearing appendix can be left in place. There is no difference in time to full recovery between open and laparoscopic appendectomy in appendicitis confirmed at DL. Choice of method for appendectomy depends on surgeon preference.},
  author       = {Moberg, Ann-Cathrin},
  isbn         = {91-628-6322-3},
  keyword      = {Surgery,orthopaedics,complications,laparoscopy,diagnostic laparoscopy,ortopedi,traumatologi,traumatology,Kirurgi},
  language     = {eng},
  pages        = {107},
  publisher    = {ARRAY(0x920fad0)},
  title        = {Laparoscopy Diagnostic applications in suspected appendicitis and access-related complications},
  year         = {2005},
}