Appendix stump closure with endoloop in laparoscopic appendectomy.

AIM: To address the question of the appendix stump closure in laparoscopic appendectomy and evaluate the incidence of intraoperative and postoperative complications after application of endoloops. MATERIAL OF STUDY: Data included age and gender, ASA score, co-morbid illness, prior abdominal surgery, clinical presentation, operative time, conversion rate and reasons for conversion, postoperative morbidity and mortality rates, pathologic diagnosis, and length of hospital stay. RESULTS: Laparoscopic appendectomy with stump closure using endoloops was performed in 35 consecutive patients. Postoperative complications occurred in three patients. The mean postoperative hospital stay was 2 days. The perioperative mortality rate was 0%. DISCUSSION: The treatment of appendiceal stump closure in laparoscopic appendectomy represents the main technical aspect and it is an important step for its potentially serious postoperative complications due from an inappropriate management. Endostapling, hem-o-lok clips and intracorporeal knotting are the most commonly recommended methods. All alternatives have advantages and disadvantages against the different clinical stages of acute appendicitis, and it should be noted that the different forms of appendiceal stump closure have never been assessed in prospective randomized studies. CONCLUSIONS: From our experience we can confirm that the endoloop can be safely used and should be the preferred modality in treating the appendiceal stump, especially for low-grade appendicitis. Alternative methods should be used in case of phlegmonous or gangrenous appendicitis, perityphlitic abscess or simultaneous operation for Meckel's diverticulum. Knowledge about and appropriate use of all of them are important for a safe and more cost-effective procedure. KEY WORDS: Appendiceal stump closure, Laparoscopic appendectomy.

Can laparoscopic cholecystectomy be safety performed in the elderly?

AIM: To assess the suitability of laparoscopic cholecystectomy in elderly patients, although early reports have questioned the efficacy of this procedure in that patient group. MATERIAL OF STUDY: Retrospective study evaluating the medical records of the elderly patients who underwent laparoscopic cholecystectomy in our surgical unit. Data included age and gender, American Society of Anesthesiologists (ASA) score, comorbid illness, prior abdominal surgery, presentation, operative time, conversion rate, postoperative morbidity, and mortality rates and length of hospital stay. RESULTS: Fifty consecutive patients age 70 or older who underwent laparoscopic cholecystectomy were studied Postoperative complications occurred in five patients. DISCUSSION: Many Studies have shown that the incidence of complicated gallstone disease in the elderly is higher when compared with that of younger patients and gallbladder disease is particularly virulent in the elderly, with high rate of acute cholecystitis, biliary tract disease, increased morbidity, and prolonged hospital stay. This poor outcome has been attributed to the presence of severe co-morbid factors associated with the aging process. Compared to open cholecystectomy, laparoscopic cholecystectomy may cause less postoperative depression of respiratory function and cell-mediated immunity. In our study perioperative mortality rate was 0%. CONCLUSIONS: Laparoscopic cholecystectomy in elderly patients is a relatively safe procedure that can be accomplished with acceptable low morbidity. In this series of geriatric patients, there was no evidence of any increased risk for conversion to an open cholecystectomy, delayed recovery, or prolonged hospitalization.