Cœlioscopic appendectomy (CA): indication and interest of the three procedures. A personal, continuous, exclusive series of 1041 cases

In 1990, we suggested the classification of the CA in three procedures, used by Ph. Mouret and adopted by GF. Begin in «Techniques – Encyclopédie Médico chirurgicale».Objective. To clarify the indications and interest of each of the three procedures.This series is personal, continuous, and exclusive, with:-512 (50%) CA «out», extra-abdominal: full abdominal exploration, location of the appendix treated by micro Mac Burney «loco optimo» with a perforating stitch;-182 (17%) CA «in» intra-abdominal with the most convenient extraction;-347 (33%) CA «mixed»: mobilization of the appendix, intra-abdominal hemostasis of the meso, and extra-abdominal suture of the stump.Results. Preferential indications: CA «out» is the best procedure for thin abdominal walls, little children, children and young patients with a supple appendix, CA «mixte» for appendix with adhesions or with a fat meso, CA «in» for all cases but especially for obese, thick abdominal walls, and complicated cases.Main complications. Intra-abdominal postoperative abscess (AIS) only occurred (0,19/1041) in CA «in» with 1,09% / 182 but 2% if deducting the CA «in» with endo stapler. The stumps treated extra-abdominally for 860 CA «out» and CA «mixte» gave no AIS.Conclusion. In 1041 cases, the satisfying rate of 0,19% AIS is linked to 0% of the stumps treated on the skin with a perforating stitch for 860 CA «out» et CA «mixed», in spite of 1,09% for 182 CA «in», and 2% for sutures with endo-abdominal loop.The CA « out » and « mixed » procedures must be privileged, when feasible.