Appendectomies by celioscopy. Results in 78 patients]

The recent development of laparoscopic surgery has included the treatment of acute appendicitis. We report our results after three years' experience of this type of surgery. We have operated on 78 patients (54 men, 44 women) mean age 28.9 years, suspected of varying degrees of acute appendicitis. The operation was completely carried out by laparoscopy on 71 occasions, including treatment of an abscess in 4 cases and peritonitis in 4 cases (3 of which were sub-mesocolic and one was generalised). The laparoscopy was transformed into laparotomy in 7 cases, 4 of which were due to difficulties of appendix dissection. Mortality was zero. Four complications occurred: 2 minute infections of the trocar hole, one more severe parietal infection which was a cause of readmission and antibiotic treatment, one "syndrome of the fifth day". In conclusion, laparoscopic appendicectomy appears to be quite feasible in the majority of cases, particularly when the appendix is ectopic, with marked abdominal thickening and peritoneal reaction. The postoperative course is uneventful. The laparoscopic technique is very comfortable for the patient during the postoperative period. This technique is becoming increasingly feasible with the operator's experience, and this appears to us to constitute good training for any form of laparoscopic surgery.     

Biliary cysts. Resection of the protruding dome using celioscopy]

After giving the highlights on the few surgical indications of biliary cysts, the authors present a film of the resection of the protruding dome with celioscopy for an 80-mm cyst of the 3rd segment of the liver, in association with cholecystectomy for lithiasis. The simple technique and uncomplicated postoperative period emphasize the merits of this procedure, although this should not lead to inappropriate indications.     

Appendectomy with intraoperative celioscopy in children. 465 cases]

The authors report a retrospective series of 465 appendectomies with intraoperative celioscopy in children under age 16. The technical issues and the indications are discussed. The results are the following: No death, 3.6% intraoperative incidents of no consequence, 3% postoperative complications, including 1.3% requiring second surgery or celioscopy. These results are better than those obtained with conventional surgery. The advantages of appendicectomy with intraoperative celioscopy are the following: easy, quick search for the appendix, whatever its location, exploration of the entire abdominal cavity, possibility to perform a complete peritoneal washing, suppression of parietal complications, and almost no skin scar, definite reduction in the number of intraperitoneal residual abscesses, and likely reduction of postoperative adhesions, which are a cause of obstruction, of chronic pain and of infertility in girls, rapid resumption of transit and of all activities, including sports.     

Anesthesia accidents: accidental esophageal intubation]

Accidental oesophageal intubation is a common mistake in inexperienced anaesthetists, but unrecognized oesophageal intubation is fortunately a rare event because, in anaesthetic malpractice claims, it frequently resulted in death or brain damage. The connection of these complications with the lack of experience of the anaesthetist and/or the difficult intubation is not so evident in the literature. The precocious detection of tube dislocation depends on the systematic verification of endotracheal tube position after insertion. The paper describes the clinical and instrumental tests used for detecting tracheal or oesophageal intubation. Clinical signs are often unreliable and, between technical tests, capnography is the most reliable of correct tracheal positioning if waves are regular and repeated; when unavailable, the negative pressure aspiration test is a simple and reliable alternative.     

Contribution of celioscopy in the early diagnosis of ovarian cancers]

Four hundred and eighty-one patients with an ovarian cyst considered to be benign on the basis of clinical and ultrasonographic findings underwent diagnostic laparoscopy. All malignant tumours (9 cases) were recognized by diagnostic laparoscopy and were treated immediately via laparotomy. When a cyst was identified as being benign on laparoscopy, the diagnosis was always confirmed by histological examination. Sixty one patients (64 cysts) were treated via laparotomy immediately after laparoscopy for the following reasons: malignant or suspicious lesions (19 cases) dense adhesions or anatomical conditions making laparoscopic surgery difficult (42 cases). 420 patients (444 cysts) were treated by laparoscopic surgery with either intraperitoneal cystectomy or transparietal cystectomy. The postoperative course following laparoscopic surgery for annexal cysts was uneventful in 417 cases (3 patients developed a complication).     

Intra-peritoneal appendectomy by celioscopy. Preliminary results of a new technique]

The diagnostic and therapeutic value of laparoscopic surgery is known for ovarian cysts and ectopic pregnancies. The diagnostic of appendicitis is difficult and laparoscopy is useful. The aim of this study is to assess the feasibility, the efficacy and the advantages of a new technique of laparoscopic appendectomy. From August 1, 1989 to July 31, 1990 the women seen for pelvic pain have been divided in three groups: appendicitis, pelvic inflammatory disease (PID) and doubt. Intra peritoneal appendectomy has been performed if the laparoscopic diagnosis was not PID. Via three supra symphyseal trocars the appendix has been exposed and his meso coagulated. The appendix stump has been closed with a clip applicator (Ethnor T1300). Thirty-one women have been involved in this study. Twenty women had a laparoscopic appendectomy. Mean operation time was 36 minutes. In no occasion laparotomy was necessary. There was no post-operative complication and stool was obtained on the second post operative day. Patients and nurses appreciation was excellent. This operative procedure was possible in each attempt. This technique is sure, quick and easily reproducible. Comfortable post operative period and esthetic advantage have been noticed by the women. This operation has been possible in each attempt. This technique is sure, quick and easily reproducible.