Study reviews appendix operations

Published 9:00 pm Sunday, December 21, 2003

DURHAM, N.C. — When an appendix needs to be removed, patients who have minimally invasive surgery fare far better than those who have traditional operations, a review of several studies indicates.

Patients who had laparoscopic appendectomies had fewer complications, left the hospital faster and went back to work sooner, two Duke University researchers found after reviewing results of studies involving 43,000 patients.

The analysis is not definitive, the doctors said. "But we have seen definite advantages to laparoscopies," said Dr. Ricardo Pietrobon, who did the analysis with Dr. Ulrich Guller. Their findings are being published in the January edition of Annals of Surgery.

In laparoscopy, surgeons make short incisions, about a quarter-centimeter in length, then insert a tiny camera to guide them as they use cutters, staplers and a tiny sterile bag to remove the appendix.

That compares with the traditional procedure, in which a surgeon cuts a 5- to 6-centimeter slit in the lower right section of the abdomen. Despite stringent sterilization, the wound can become infected while the organ is removed.

Dr. Craig Fischer, assistant professor of surgery at the University of Texas Medical School at Houston, said he uses laparoscopy about 90 percent of the time for appendectomies.

"You put the appendix inside this tiny sterile bag, tie the bag’s string so the appendix doesn’t drip into the abdomen, and pull it through," Fischer said. "The appendix is squishy, so it’ll go through a smaller hole, and the bag cuts down on infection significantly."

Doctors say the bag doesn’t work in a traditional procedure, possibly because the incisions create a bigger pool in which the bacteria can swim. In laparoscopy, the appendix doesn’t move until it’s time to remove it, Fischer said.

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