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Laparoscopic Appendectomy in Children: Preliminary Study in Pediatric Hospital Albert Royer, Dakar.

Fall M, Gueye D, Wellé IB, Lo FB, Sagna A, Diop M, Fall I - Gastroenterol Res Pract (2015)

Bottom Line: Appendiceal pathology's management has benefited in recent years from the advent of laparoscopic surgery.Appendectomy was associated with peritoneal wash in 17 patients including 9 cases of acute appendicitis.After an average of 8 months no other problems were noted.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Surgery Department, Children Hospital Albert Royer, Dakar, Senegal.

ABSTRACT
Appendiceal pathology's management has benefited in recent years from the advent of laparoscopic surgery. This study is to make a preliminary assessment of laparoscopic management of acute and complicated appendicitis in children after a few months of practice at the University Hospital Albert Royer, Dakar. This is a retrospective study of 22 cases of patients, all operated on by the same surgeon. The parameters studied were age, sex, clinical data and laboratory features, radiological data, and results of surgical treatment. The mean age of patients was 9.5 years with a male predominance. The series includes 14 cases of acute appendicitis and 8 complicated cases. Appendectomy anterograde is practiced in 81% of cases. Appendectomy was associated with peritoneal wash in 17 patients including 9 cases of acute appendicitis. Drainage of Douglas pouch is performed in 2 patients with complicated appendicitis; the average production was 300 cc of turbid liquids and any complications were not founded. An abscess of Douglas pouch is noted in 2 patients with complicated appendicitis undrained. These Douglas abscesses were treated medically. No conversion of laparotomy was performed in the series. After an average of 8 months no other problems were noted.

No MeSH data available.


Related in: MedlinePlus

Extraction of the appendix through the umbilical trocar.
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Related In: Results  -  Collection


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fig4: Extraction of the appendix through the umbilical trocar.

Mentions: This is a retrospective study about patients incurring laparoscopic appendectomy in the period from May 2013 to November 2014 in the Pediatric Surgery Department, Hospital Albert Royer, Dakar. We used general anesthesia with orotracheal intubation, nasogastric tube, and a urinary catheter. The patient is supine with the left arm along the body. The operator and his assistant are placed at the left of the patient and column laparoscopy is facing surgeons. The umbilicus is gripped between two Kelly clamps, everted, and opened. The fascial hole is then expanded and the peritoneum opened with a pair of scissors. We introduce an umbilical trocar around the fascia hole. The “open coelioscopy” finishing the wire is tight and rolled at the end of the umbilical trocar and then clamped by a Kelly's clamp (Figure 1). The CO2 insufflation is started at a pressure of 12 mmHg and a flow rate of 4 L/minute. Two 5 mm trocars are then placed a finger's breadth above the pubic bone and on the left iliac fossa. A scanning optics and a sequence of intestines allow exploration of the abdominal cavity (Figure 2). Hemostasis is made by coagulating the mesoappendix sometimes with bipolar hook. For ligation of the appendicular base we use a lasso of resorbable wire 3/0 handmade in extracorporeal and introduced by 5 mm trocar the left iliac fossa (Figure 3). The lasso is threaded around the appendix and is tight at the base. The appendix section is made above the node and the appendix is immediately extracted through the umbilical trocar (Figure 4). Depending on the case a suction-washing is optionally performed with a drainage (Figure 5). The trocars are removed under direct vision followed by a full exsufflation pneumoperitoneum. Umbilical foramen is tight in order to close the opening fascia. Trocar orifices of 5 mm are closed by 1 or 2 points of resorbable wire 4/O. A bandage is placed on the umbilicus for a period of 5 days.


Laparoscopic Appendectomy in Children: Preliminary Study in Pediatric Hospital Albert Royer, Dakar.

Fall M, Gueye D, Wellé IB, Lo FB, Sagna A, Diop M, Fall I - Gastroenterol Res Pract (2015)

Extraction of the appendix through the umbilical trocar.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4581568&req=5

fig4: Extraction of the appendix through the umbilical trocar.
Mentions: This is a retrospective study about patients incurring laparoscopic appendectomy in the period from May 2013 to November 2014 in the Pediatric Surgery Department, Hospital Albert Royer, Dakar. We used general anesthesia with orotracheal intubation, nasogastric tube, and a urinary catheter. The patient is supine with the left arm along the body. The operator and his assistant are placed at the left of the patient and column laparoscopy is facing surgeons. The umbilicus is gripped between two Kelly clamps, everted, and opened. The fascial hole is then expanded and the peritoneum opened with a pair of scissors. We introduce an umbilical trocar around the fascia hole. The “open coelioscopy” finishing the wire is tight and rolled at the end of the umbilical trocar and then clamped by a Kelly's clamp (Figure 1). The CO2 insufflation is started at a pressure of 12 mmHg and a flow rate of 4 L/minute. Two 5 mm trocars are then placed a finger's breadth above the pubic bone and on the left iliac fossa. A scanning optics and a sequence of intestines allow exploration of the abdominal cavity (Figure 2). Hemostasis is made by coagulating the mesoappendix sometimes with bipolar hook. For ligation of the appendicular base we use a lasso of resorbable wire 3/0 handmade in extracorporeal and introduced by 5 mm trocar the left iliac fossa (Figure 3). The lasso is threaded around the appendix and is tight at the base. The appendix section is made above the node and the appendix is immediately extracted through the umbilical trocar (Figure 4). Depending on the case a suction-washing is optionally performed with a drainage (Figure 5). The trocars are removed under direct vision followed by a full exsufflation pneumoperitoneum. Umbilical foramen is tight in order to close the opening fascia. Trocar orifices of 5 mm are closed by 1 or 2 points of resorbable wire 4/O. A bandage is placed on the umbilicus for a period of 5 days.

Bottom Line: Appendiceal pathology's management has benefited in recent years from the advent of laparoscopic surgery.Appendectomy was associated with peritoneal wash in 17 patients including 9 cases of acute appendicitis.After an average of 8 months no other problems were noted.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Surgery Department, Children Hospital Albert Royer, Dakar, Senegal.

ABSTRACT
Appendiceal pathology's management has benefited in recent years from the advent of laparoscopic surgery. This study is to make a preliminary assessment of laparoscopic management of acute and complicated appendicitis in children after a few months of practice at the University Hospital Albert Royer, Dakar. This is a retrospective study of 22 cases of patients, all operated on by the same surgeon. The parameters studied were age, sex, clinical data and laboratory features, radiological data, and results of surgical treatment. The mean age of patients was 9.5 years with a male predominance. The series includes 14 cases of acute appendicitis and 8 complicated cases. Appendectomy anterograde is practiced in 81% of cases. Appendectomy was associated with peritoneal wash in 17 patients including 9 cases of acute appendicitis. Drainage of Douglas pouch is performed in 2 patients with complicated appendicitis; the average production was 300 cc of turbid liquids and any complications were not founded. An abscess of Douglas pouch is noted in 2 patients with complicated appendicitis undrained. These Douglas abscesses were treated medically. No conversion of laparotomy was performed in the series. After an average of 8 months no other problems were noted.

No MeSH data available.


Related in: MedlinePlus