Laparoscopy Assisted Appendectomy in Adult Patients: The Two Trocar Technique

Yıl 2024, Cilt: 5 Sayı: 3, 94 - 97, 27.12.2024

İlker Pala , Muhammed Kadir Yıldırak

Öz

Background: Acute appendicitis is the most common surgical emergency encountered in general surgery practices. Laparoscopic appendectomy has widely replaced open conventional appendectomy, since it is associated with better surgical and esthetic outcomes, less postoperative pain and early return to work. However, it is also associated with high costs. To combine the cost-effectiveness of conventional surgery and advantages of laparoscopic surgery, the two trocar technique has evolved and been gaining attention. In this study, we aimed to present the results of our patients, who underwent laparoscopic assisted appendectomy in a tertiary surgery clinic.
Material and Methods: 42 patients were enrolled in the study. Their age, sex, postoperative VAS scores, peroperative complications (superficial wound infection, intraabdominal abscess, bleeding) and durations of stay were recorded.
Results: Mean age of patients were 32,09±9,17. 32 of patients were male and 10 were female. Average VAS scores in postoperative 12 hours and 24 hours were 6,26±1,17 and 3,12±0,99, respectively. All patients were discharged on postoperative 24 hours. 2 patients developed surgical site infection and 1 patient developed intraabdominal abscess. Ne event of bleeding occurred.
Conclusion: Two trocar technique is a safe and favorable method in selected patients in treatment of acute appendicitis with high cost-efficiency.

Anahtar Kelimeler

Acute Appendicitis, Two Trocar Technique, High Cost-Efficiency

Erişkinlerde Laparoskop Yardımlı Appendektomi: Çift Trokar Tekniği

Öz

Giriş: Genel Cerrahi pratiğinde en sık görülen acil hastalık akut apandisittir. Daha iyi cerrahi ve estetik sonuçlara sahip olması, daha az postoperatif ağrı ve iş gücü kaybıyla ilişkili olması nedeni ile laparoskopik yöntem geleneksel açık yöntemin yerini almıştır. Ancak bu yöntem yüksek maliyet ile de ilişkilidir. Geleneksel açık cerrahinin maliyet etkinliği ile laparoskopik cerrahinin avantajlarını bir arada elde edebilmek amacı ile çift trokar tekniği geliştirilmiştir. Biz de bu çalışmamızda üçüncü basamak cerrahi kliniklerinde bu yöntem ile laparoskopik appendektomi operasyonu geçiren hastaların sonuçlarını paylaşmayı amaçladık.
Materyal ve Metod: Çalışmaya 42 hasta dahil edildi. Yaş, cinsiyet, postoperatif VAS skorları, peroperatif komplikasyonlar (yüzeyel yara yeri enfeksiyonu, intraabdominal apse, kanama) ve hastanede kalış süreleri kaydedilerek incelendi.
Bulgular: Hastaların yaş ortalaması 32,09±9,17 olarak bulundu. Cinsiyet dağılımında 32 hasta erkek 10 hasta kadın idi. Postoperatif 12. ve 24. saatte ortalama VAS skorları sırasıyla 6,26±1,17 ve 3,12±0,99 olarak bulundu. Tüm hastalar postoperatif 24. saatte taburcu edildi. Takiplerinde iki hastada yüzeyel yara yeri enfeksiyonu ve 1 hastada karın içi apse gelişti. Herhangi bir hastada peroperatif kanama olmadı.
Sonuç: Çift trokar tekniği akut apandisit tanısı ile acil opere edilecek seçilmiş hastalarda yüksek maliyet etkinliği nedeni ile tercih edilebilir ve güvenli bir yöntemdir.

Anahtar Kelimeler

Akut Apandisit, Çift Trokar Tekniği, Yüksek Maliyet Etkinliği

Kaynakça

• 1. Brown-Forestiere R, Furiato A, Foresteire NP, Kashani JS, Waheed A. Acute appendicitis: clinical clues and conundrums related to the greatest misses. Cureus. 2020;12(5):e8051. https://doi.org/10.7759/cureus.8051
• 2. McBurney C. IV. The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg. 1894;20(1):38–43. https://doi.org/10.1097/00000658-189407000-00004
• 3. Mancini GJ, Mancini ML, Nelson HS Jr. Efficacy of laparoscopic appendectomy in appendicitis with peritonitis. Am Surg. 2005;71(1):1–5. https://doi.org/10.1177/000313480507100101
• 4. Pokala N, Sadhasivam S, Kiran RP, Parithivel V. Complicated appendicitis –is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting. Am Surg. 2007;73(8):737–742. https://doi.org/10.1177/000313480707300801
• 5. Cárdenas-Salomon CM, Cervantes-Castro J, Jean-Silver ER, Toledo-Valdovinos SA, Murillo-Zolezzi A, Posada-Torres JA. Hospitalization costs of open vs. laparoscopic appendectomy: 5-year experience. Cir Cir. 2011;79(6):534–539.
• 6. Buitrago G, Junca E, Eslava-Schmalbach J, Caycedo R, Pinillos P, Leal LC. Clinical outcomes and healthcare costs associated with laparoscopic appendectomy in a middle-income country with universal health coverage. World J Surg. 2019;43(1):67–74. https://doi.org/10.1007/s00268-018-4777-5
• 7. Rammohan A, Jothishankar P, Manimaran AB, Naidu RM. Two-port vs. threeport laparoscopic appendicectomy: A bridge to least invasive surgery. J Minim Access Surg. 2012;8(4):140–144. https://doi.org/10.4103/0972-9941.103121
• 8. Olijnyk JG, Pretto GG, da Costa Filho OP, Machado FK, Silva Chalub SR, Cavazzola LT. Two-port laparoscopic appendectomy as transition to laparoendoscopic single site surgery. J Minim Access Surg. 2014;10(1):23–26. https://doi.org/10.4103/0972-9941.124460
• 9. Saidi HS, Adwok JA. Acute appendicitis: an overview. East Afr Med J. 2000;77(3):152–156. https://doi.org/10.4314/eamj.v77i3.46612
• 10. Weiner RA, Blanco ER, Weiner S. Akute Appendizitis –Laparoskopische Appendektomie– Indikation und Ergebnisse [Acute appendicitis –laparoscopic appendectomy– indications and outcomes]. Kongressbd Dtsch Ges Chir Kongr. 2002;119:204–209. https://doi.org/10.1007/978-3-642-55715-6_117
• 11. Nguyen A, Lotfollahzadeh S. Appendectomy. [Updated 2023 Jun 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK580514/
• 12. Kössler-Ebs JB, Grummich K, Jensen K, Hüttner FJ, Müller-Stich B, Seiler CM, et al. Incisional hernia rates after laparoscopic or open abdominal surgery–a systematic review and meta-analysis. World J Surg. 2016;40(10):2319–2330. https://doi.org/10.1007/s00268-016-3520-3
• 13. Jaschinski T, Mosch CG, Eikermann M, Neugebauer EA, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018;11(11):CD001546. https://doi.org/10.1002/14651858. CD001546.pub4
• 14. Yau KK, Siu WT, Tang CN, Yang GP, Li MK. Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg. 2007;205(1):60– 65. https://doi.org/10.1016/j.jamcollsurg.2007.03.017
• 15. Cipe G, Idiz O, Hasbahceci M, Bozkurt S, Kadioglu H, Coskun H, et al. Laparoscopic versus open appendectomy: where are we now? Chirurgia (Bucur). 2014;109(4):518–522.
• 16. Patel SV, Nanji S, Brogly SB, Lajkosz K, Groome PA, Merchant S. High complication rate among patients undergoing appendectomy in Ontario: a population-based retrospective cohort study. Can J Surg. 2018;61(6):412–417. https://doi.org/10.1503/cjs.011517
• 17. Gupta R, Sample C, Bamehriz F, Birch DW. Infectious complications following laparoscopic appendectomy. Can J Surg. 2006;49(6):397–400.
• 18. Rao AD, Tan CBD, Singaporewalla RM. Laparoscopic appendectomy translates into less analgesics and faster return to work in Asia. JSLS. 2022;26(2):e2022.00006. https://doi.org/10.4293/JSLS.2022.00006
• 19. Scott NB. Wound infiltration for surgery. Anaesthesia. 2010;65 Suppl 1:67-75. https://doi.org/10.1111/j.1365-2044.2010.06241.x
• 20. Gorter RR, Heij HA, Eker HH, Kazemier G. Laparoscopic appendectomy: state of the art. Tailored approach to the application of laparoscopic appendectomy? Best Pract Res Clin Gastroenterol. 2014;28(1):211–224. https://doi.org/10.1016/j.bpg.2013.11.016
• 21. Malhotra L, Pontarelli EM, Grinberg GG, Isaacs RS, Morris JP, Yenumula PR. Cost analysis of laparoscopic appendectomy in a large integrated healthcare system. Surg Endosc. 2022;36(1):800–807. https://doi.org/10.1007/s00464-020-08266-0
• 22. Singh A, Anand S, Pakkasjärvi N, Verma A, Bajpai M. Energy devices for clipless-sutureless laparoscopic appendectomy: a systematic review and metaanalysis on utility and safety. Medicina (Kaunas). 2022;58(11):1535. https://doi.org/10.3390/medicina58111535
• 22. Fazili FM, Al-Bouq Y, El-Hassan OM, Gaffar HF. Laparoscope-assisted appendectomy in adults: the two-trocar technique. Ann Saudi Med. 2006;26(2):100–104. https://doi.org/10.5144/0256-4947.2006.100
• 23. Nicholson T, Tiruchelvam V. Comparison of laparoscopic-assisted appendectomy with intracorporal laparoscopic appendectomy and open appendectomy. JSLS. 2001;5(1):47–51.