The technique of closure of the appendiceal

The technique of closure of the appendiceal selleck chem Tofacitinib stump in LA varies greatly. Usually, a noninversion of the appendiceal stump is performed in conventional three-trocar LA. This circumstance could explain a higher rate of intraabdominal abscess in conventional LA. Since the introduction of SPA in mid-2005 at our department, the appendiceal stump is ligated, inverted, and closed by one z-shaped suture. As reported earlier [6], we encountered 6 cases of intraabdominal abscess after SPA. All of them occurred in obese children (BMI > 95th percentile) with perforated appendicitis. In four of them, the surgeon carried out a lavage of the peritoneal cavity with saline. Despite a controversial discussion in the literature [15, 16], we hypothesize that the saline lavage may be responsible for bacterial spread throughout the abdomen and the cause of intraabdominal abscess.

Due to this experience, we only perform suction of the abdominal fluid collections and no more lavage. A review of the literature shows no significant difference in the incidence of intraabdominal abscess when comparing the suture technique with endoloop and stapler to endoloop only for appendiceal stump closure [17]. But there is a noteworthy difference with regards to the cost. The decision as to which LA-technique to use depends on its safety and cost. In our opinion, SPA joins the safety of OA (i.e., dissection under direct view) and the advantages of conventional LA (i.e., small skin incision and visibility of the entire abdominal cavity). Different ways to close the appendiceal stump exist such as stapler, clips, endoloop, or endobag [18].

In contrast to several reports of single-port or single-incision laparoscopic appendectomy [19], techniques that involve special trocar, and multiple instruments [20], our SPA-technique requires only one trocar (USD 172) and one conventional laparoscopic instrument and does not necessitate the use of expensive equipment such as retrieval pouch. Regarding these facts, our SPA-technique is less expensive than conventional three-trocar LA reported elsewhere [21, 22]. Closing the appendiceal stump using two 3/0 vicryl RB-1 sutures (USD 15) is 5.9 times less costly than by endoloop and 18.4 times less costly than by stapler. Our median operating time of 55min. was slightly higher than those reported in the literature [22], which is related to our learning curve.

Especially in complicated appendicitis, the operative time was higher than 55 min., as reported Brefeldin_A in the literature [23]. Safety of surgical techniques is one of the primary concerns in the literature; the safety of a surgical technique is characterized by its rate of complications. Table 1 displays the main outcomes of a review of the literature concerning laparoscopic-assisted single-port appendectomy.

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