Avaliação da efetividade e segurança da apendicectomia videoassistidatransumbilical em adolescentes e adultos

Abstract

Video-assisted transumbilical appendectomy, initially performed in children, aims to associate the benefits of laparoscopic approach and the safety and simplicity of open appendectomy. The effectiveness and safety of the method were, retrospectively, evaluated in 300 adults and adolescents with suspected acute appendicitis. The factors associated with procedure conversion to open or laparoscopic approach werealso analyzed. The surgical act starts with introduction of an optic with operative channel through an umbilical only incision. Diagnostic laparoscopy was performed and vermiform appendix identified. Then, the organ was exteriorized with video assistance through umbilical incision and its removal was performed just like in open technique. The medium age was 28.7 years and 76% of the patients were females. Surgical mean time was 52.1 minutes. Conversion to open procedure or laparoscopic approach was necessary in 9% of cases. Conversion main causes were severe local inflamatory adhesions and advanced phases of acute appendicitis. The incidence of post-operative complications was 6.6% being 1.3% of intra-abdominal abscess and 2% of surgical site infection. There were no deaths. Histopathological examination confirmed 11.7% of advanced phases appendicitis, 79.3% in early stages and 2.7% of normal appendices. Video-assisted transumbilical appendectomy showed to be feasible, efficient and safe. Statistically significant factor associated with procedure conversion was complicated appendicitis (necrotic and perforated) identified during surgery. The results from this study and the technique´s benefits could avail therecomendation of this method, as an initial approach, in adolescents and adults with suspected acute appendicitis.