More than 500 laparoscopic surgeries were undertaken on patients with diagnosis of acute appendicitis in surgical clinic of Aktobe Railroad hospital in 2005–2015. A complicated form of acute appendicitis was revealed among 143 patients. However, not all of the undertaken surgeries were finished successfully. Laparoscopic appendectomy (LA) in complicated forms included:
1) diagnostic stage – evaluation of changes in vermicular sprout, nature of complication severity in stomach cavity;
2) laparoscopic appendectomy with intra-abdominal sanitization;
3) control dynamic laparoscopy (according to indications).
A dense appendicular infiltrate without abscess was registered among 6 patients, in these cases microirrigators were placed for antibiotic discharge. Assisted appendectomy was carried out on 7 patients, complication severity was registered. After analyzing the received results, we have defined the following contraindications for laparoscopic appemdectomy in complicated cases of acute appendicitis:
1) perforation of sprout foundation;
3) diffuse purulent peritonitis;
4) dense appendicular infiltrate.
Results of treating patients with complicated forms of appendicitis are presented in this report. Ligature method was implemented on 93 patients. Among other 40 patients a modified method was used in respect to various categories of intraperitoneal complications. In 36 cases laparoscopic appendectomy was carried out with access through 4 points, and for 5 patients stump was placed into the wall of blind gut through intracorporal cuts – two crossed cuts of Z form. Our results prove significant advantages of laparoscopic appendectomy in comparison to traditional methods. Innovative method allowed us to decrease frequency of post-surgical complications from 23 % to 4,2 %, secondary surgeries – from 10,2 % to 2,3 %. No lethal results happened. Thus, provided with technical equipment and clear definition of indications laparoscopic appendectomy is the selected method of treating complicated forms of acute appendicitis.