Tactical approaches to the surgical treatment of patients with complicated forms of acute appendicitis and abdominal sepsis with a high risk of cardiopulmonary insufficiency

Abstract

Purpose of the study. To determine the feasibility and effectiveness of the laparoscopic method of treatment of patients with complicated forms of acute appendicitis. in patients with high risk of cardiopulmonary failure and to determine the indications for the use of various methods of laparoscopic appendectomy. Materials and methods. The result of treatment of 67 patients with acute appendage with high risky cardiopulmonary insufficiency. Of these, 10 patients (14,9%) were diagnosed with sepsis. The patients were divided into two groups: Group I: 29 (43,3%) patients with complicated acute appendicitis, with a high risk of cardiopulmonary insufficiency, who underwent open appendectomy. Open appendectomy was performed according to the standard procedure from the Volkovich-Dyakonov (Mac-Burney) incision in 19 (65,5%) patients, in 10 (34,5%) median laparotomy. Group II: 38 (56,7%) patients with complicated acute appendicitis who underwent laparoscopic appendectomy, and drainage of the abdominal cavity. Classical laparoscopic surgery with the imposition of pneumoperitoneum was performed in 20 (29,8%) patients and using the laparolifting method in 18 (26,9%) patients Results. 38 (56,7%) patients were operated on using laparoscopic techniques. During laparoscopic interventions, intraoperative revision and appendectomy were performed. This technique is absolutely safe, reliable and affordable in the performance of most surgeons. Conclusions. Laparoscopic appendectomy with complicated forms of acute appendicitis can be performed in almost all patients with acute appendicitis with a high risk of cardiopulmonary insufficiency.

Keywords

• acute appendicitis
• complicated appendicitis
• appendectomy
• cardiopulmonary insufficiency
• laparoscopy
• sepsis