Scientific journal
European Journal of Natural History
ISSN 2073-4972

LAPAROSCOPIC ASPECT IN SURGERY OF COMPLICATED APPENDICITIS

Baizharkinova A.B. 1 Zhanilsinov S.S. 1 Suyendikov T.S. 1
1 State Medical University of Marat Ospanov and Railroad Clinic Hospital

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;

2) typhlitis;

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.