ABSTRACT
Background: There have been numerous techniques used in laparoscopic appendectomy (LA) to divide the mesoappendix, including LigaSure, Harmonic scalpel, clips, endoloop ligatures, Endo GIA staplers, and bipolar coagulation. However, few studies have investigated monopolar diathermy for mesoappendix division. Therefore, this study aimed to assess both its safety and efficacy in LA. Method(s): In this prospective non-randomized study, patients (n = 87) who underwent LA for acute appendicitis were included. The bipolar electrocautery was used for mesoappendix division in the first 33 patients (BC group), while the monopolar electrocautery was used in the next 54 patients (MC group). Result(s): The median operative time was significantly shorter in the MC group (42 min. vs 47 min. in BE group, p = 0.01). One patient converted to open surgery in the MC group due to uncontrollable bleeding. There were no significant differences between both groups regarding postoperative complications and hospital stay (p = 0.91, p = 0.13, respectively). Conclusion(s): Monopolar electrocautery is safe and effective for mesoappendix division in LP in comparison to bipolar electrocautery. However, larger and multicentric studies are required to validate our results.Copyright © 2023 The Authors
ABSTRACT
Acute appendicitis (AA) is the most common cause of acute surgical abdominal pain in patients all over the world. Appendectomy (AE) is still associated with relatively high risk of surgical site infection (SSI), regardless of surgical technique and approach, de-spite decades of practice. The incidence of SSI is 7% overall, ranging from 0 to 37.4%. According to various authors, SSI risk factors can be: conversion, experience of the surgeon, the type of inflammation of the process and the timing of the disease, the severity of systemic inflammation, operations at night, some signs according to CT, the features of surgical technique, and even COVID-19. But neither of authors point the laparoscopic approach as an independent risk factor for SSI, however, some of them was hypothesized that carboxyperitoneum and thermal exposure of surgical energy can damage the mesothelium and promote the translocation of microorganisms. Modern methods for diagnosing and assessing SSI after AE are also considered in this re-view: computed and magnetic-resonance imaging, as well as ultrasound diagnostics also with elastography. Thoroughly adher-ence to international guidelines for the prevention of SSI can reduce it incidence, however world experience shows that the list of measures to reduce the risk of SSI development is not limited to this. The surgical community is off to develop clear guidelines for the prevention of early SSI after AE. © 2022, Media Sphera Publishing Group. All rights reserved.