Apendicectomia videoassistida por acesso único transumbilical comparada com a laparoscópica e com a convencional como proposta de abordagem inicial da apendicite aguda

Abstract

In spite of several retrospective, prospective and meta-analysis studies compared laparoscopic appendectomy (LA) with open appendectomy (OA), controversy still persists about the best surgical technique for acute appendicitis (AA) treatment. Transumbilical laparoscopic-assisted appendectomy (TULAA) aims to combine the advantages of LA and OA. The study objective was to retrospectively compare these three techniques in adults and adolescents, configuring an original proposal in literature. Between 2000 and 2009, 1. 232 patients were included in the research. The AVATU was performed in 579 patients (47%), LA in 405 (32,9%) and OA in 248 (20,1%). The variables early and late postoperative complications and pain, operative time, hospital stay and return to normal activities were analyzed. Causes and incidence of conversion were compared, and also were complicated AA, in women and obese patients in relation to variables mentioned above. Mean operative time was 51,7 minutes for TULAA, 75,5 minutes for LA and 59,8 minutes for OA with statistical significance. Patients who underwent OA had more postoperative pain, longer hospital stay, later return to normal activities and more postoperative complications. There was no statistically significant difference between TULAA and LA in relation to these variables. 10,4% of LA cases were converted to OA and 11,9% of TULAA cases were converted to another procedures (OA, LA or two-port video-assisted appendectomy). LA demanded greater operative time in obese, in complicated forms of AA and in women compared to TULAA, and yet, longer hospital stay in females. The interpretation of results and TULAAs attractiveness can endorse the recommendation of this method in initial surgical approach of patients with suspected or confirmed AA.