First steps of laparoscopic surgery in Lubumbashi: problems encountered and preliminary results.

For many reasons, laparoscopic surgery has been performed worldwide. Due to logistical constraints its first steps occurred in Lubumbashi only in 2008. The aim of this presentation was to report authors' ten-month experience of laparoscopic surgery at Lubumbashi Don Bosco Missionary Hospital (LDBMH): problems encountered and preliminary results. The study was a transsectional descriptive work with a convenient sampling. It only took in account patients with abdominal surgical condition who consented to undergo laparoscopic surgery and when logistical constraints of the procedure were found. Independent variables were patients' demographic parameters, staff, equipments and consumable. Dependent parameters included surgical abdominal diseases, intra-operative circumstances and postoperative short term mortality and morbidity. Between 1(st)April 2009 and 28(th) February 2010, 75 patients underwent laparoscopic surgery at the LDBMH making 1.5% of all abdominal surgical activities performed at this institution. The most performed procedure was appendicectomy for acute appendicitis (64%) followed by exploratory laparoscopy for various abdominal chronic pain (9.3%), adhesiolysis for repeated periods of subacute intestinal obstruction in previously laparotomised patients (9.3%), laparoscopic cholecystectomy for post acute cholecystitis on gall stone (5.3%) and partial colectomy for symptomatic redundant sigmoid colon (2.7%). There were 4% of conversion to laparotomy. Laparoscopic surgery consumed more time than laparotomy, mostly when dealing with appendicitis. However, postoperatively, patients did quite well. There was no death in this series. Nursing care was minimal with early discharge. These results are encouraging to pursue laparoscopic surgery with DRC Government and NGO's supports.

Abordaje transumbilical en pacientes pediátricos con diagnóstico de apendicitis aguda. una serie de 424 pacientes / Transumbilical approach in pediatric patients with suspected acute appendicitis. a series of 424 patients

Antecedentes: El tratamiento de la apendicitis aguda implica su extirpación; es frecuente la solicitud de cicatrices postquirúrgicas del mejor tamaño posible. Una de las estrategias disponibles es el abordaje transumbilical. Objetivo: Describir las características clínicas y los desenlaces operatorios de los pacientes pediátricos en quienes se realiza apendicectomía vía transumbilical. Metodología: Estudio prospectivo de 424 pacientes sucesivos en cuanto a los desenlaces operatorios a corto plazo. Resultados: El tiempo promedio de intervención quirúrgica fue de 22 minutos; 95.8% de los pacientes presentó evolución satisfactoria del postquirúrgico; 1.4% de los pacientes se reintervino para drenar un absceso intracavitario residual y 0.2% presentó infección de sitio operatorio sin más complicaciones. Conclusión: El abordaje transumbilical de la apendicitis es una alternativa mínimamente invasiva para todos los estados de apendicitis aguda e implica disminución del tiempo de realización, menor estancia del posquirúrgico, menor incidencia de complicaciones y mayor conformidad con los resultados estéticos.

Background: As the treatment of acute appendicitisinvolves excision it is common for the patient to ask for thesmallest possible postsurgical scar. One available strategy is the transumbilical approach. Objective: To describe theclinical characteristics and surgical outcomes of pediatricpatients scheduled for transumbilical appendectomies. Methodology: A prospective study of 424 consecutivepatients in terms of short-term operative outcomes. Results:The average surgery time was 22 minutes. 95.8% of patientshad satisfactory postoperative evolution. 1.4% underwentsurgery to drain a residual intracavitary abscess, and 0.2% had surgical site infection without other complications. Conclusion: The transumbilical approach for the treatmentof appendicitis is a minimally invasive alternative for all acuteappendicitis states and result in decreased surgical time,shorter postoperative stays, lower incidence ofcomplications, and greater conformity with the aesthetic results.

Myxoglobulosis of appendix a rare entiy.

We describe a case of the extremely rare entity of myxoglobulosis of the appendix in an 18-year-old man who underwent laparoscopic appendectomy with the clinical diagnosis of recurrent appendicitis. Transaction of the appendix after ligation resulted in extrusion of numerous whitish egg-like globules ranging in size from 0.2 to 0.7 cm in diameter. It was initially thought to be hydatid of appendix, resulting in emergent usage of povidine iodine as scolicidal after suction of all the cysts/eggs. On microscopic examination, the globules consisted of faintly eosinophilic laminations of mucin surrounding an amorphous granular core were found. The mucin was identified by positivity with histochemical mucin stains. After thorough microscopic examination of the appendix, our case was diagnosed as myxoglobulosis due to mucosal hyperplasia, associated with luminal obstruction with possibly a membrane.

Rectus sheath abscess after laparoscopic appendicectomy.

Port site wound infection, abdominal wall hematoma and intraabdominal abscess formation has been reported after laparoscopic appendicectomy. We describe here a rectus sheath abscess which occurred three weeks after the laparoscopic appendicectomy. It was most likely the result of secondary infection of the rectus sheath hematoma due to bleeding into the rectus sheath from damage to the inferior epigastric arteries or a direct tear of the rectus muscle. As far as we are aware this complication has not been reported after laparoscopic appendicectomy.