Laparoscopic appendectomy for abscessed and necrotic appendix
Epublication WebSurg.com, Mar 2007;07(03). URL: http://websurg.com/doi/vd01en1696
This video of an emergency appendectomy demonstrates some of the advantages of the laparoscopic approach. Multiple abscess cavities are identified by a thorough exploration, including the necrotic appendix. Control of bleeding from the appendiceal artery and control of a gangrenous base of the appendix are clearly shown. This male patient had emergency surgery after a 1-week history of diffuse abdominal pain with signs of inflammatory syndrome. CT showed a pelvic abscess. The author begins the laparoscopic approach with a 1-cm incision just above the umbilicus and establishes pneumoperitoneum with the open technique. Dissection of the abscess must proceed cautiously. A suction device in tandem with a probe prove useful for continuing dissection to help mobilize the cecum. As the appendix comes into view, the author identifies the mesoappendix to begin dissection. Significant edema makes it difficult to continue dissection with the blunt probe, so the author uses bipolar cautery to begin dissection of the mesoappendix.