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The e-mémoires of the Académie Nationale de Chirurgie

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

ESTOUR E

Seance of wednesday 17 april 2013 (COMMUNICATIONS LIBRES)

Abstract

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.