Lessons learned with laparoscopic management of complicated grades of acute appendicitis.

Autor:	Gomes CA; Surgery Department, Hospital Universitario (HU) Terezinha de Jesus da Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Brasil; Hospital Universitario (HU) Universidade Federal de Juiz de Fora (UFJF), Brasil., Junior CS; Surgery Department, Hospital Universitario (HU) Terezinha de Jesus da Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Brasil; Hospital Universitario (HU) Universidade Federal de Juiz de Fora (UFJF), Brasil., Costa Ede F; Anestesiology Unit, Hospital Terezinha de Jesus da Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Brasil., Alves Pde A; Surgical Unit, Hospital Terezinha de Jesus da Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Brasil., de Faria CV; Surgical Unit, Hospital Terezinha de Jesus da Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Brasil., Cangussu IV; Surgical Unit, Hospital Terezinha de Jesus da Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Brasil., Costa LP; Internal Medicine Departament, Hospital Universitario (HU), Universidade Federal de Juiz de Fora (UFJF), Brasil., Gomes CC; Internal Medicine Departament, Hospital Universitario (HU), Universidade Federal de Juiz de Fora (UFJF), Brasil., Gomes FC; Morphology Unit, Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Brasil.
Jazyk:	angličtina
Zdroj:	Journal of clinical medicine research [J Clin Med Res] 2014 Aug; Vol. 6 (4), pp. 261-6. Date of Electronic Publication: 2014 May 22.
DOI:	10.14740/jocmr1837w
Abstrakt:	Background: Laparoscopy has not been consolidated as the approach of first choice in the management of complicated appendicitis. Methodological flaws and absence of disease stratification criteria have been implicated in that less evidence. The objective is to study the safe and effectiveness of laparoscopy in the management of complicated appendicitis according to laparoscopic grading system. Method: From January 2008 to January 2011, 154 consecutive patients who underwent a laparoscopic appendectomy for complicated appendicitis were evaluated in the prospective way. The patient's age ranged from 12 to 75 years old (31.7 ± 13.3) and 58.3% were male. Complicated appendicitis refers to gangrenous and/or perforated appendix and were graded as 3A (segmental necrosis), 3B (base necrosis), 4A (abscess), 4B (regional peritonitis) and 5 (diffuse peritonitis). The outcomes including operative time, infection complication, operative complications and conversion rate were chosen to evaluate the procedure. Results: The grade 3A was the most frequent with 50 (32.4%) patients. The mean operative time was 69.4 ± 26.3 minutes. The grade 4A showed the highest mean operative time (80.1 ± 26.7 minutes). The wound and intra-abdominal infection rates were 2.6 and 4.6%, respectively. The base necrosis was the most important factor associated with the conversion (5.2%). The grades 4A and 5 were associated with greater possibility of intra-abdominal collection. There were no operative complications. Conclusion: The laparoscopic management of all complicated grades of acute appendicitis is safe and effective and should be the procedure of first choice. The laparoscopic grading system allows us to assess patients in the same disease stage.
Databáze:	MEDLINE
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