FEATURES OF LAPAROSCOPIC APPENDECTOMY WITH THE ATYPICAL LOCATION OF THE APPENDIX IN PATIENTS WITH A HIGH RISK OF CARDIOPULMONARY INSUFFICIENCY
Keywords:acute appendicitis, appendectomy, laparoscopy, cardiopulmonary insufficiency, atypical location of the appendix
Objectives. The purpose of the work was to expand the capabilities of laparoscopic appendectomy in the atypical location of the destructively altered appendix in patients with a high risk of cardiopulmonary pathology, through the use of new surgical techniques.
Material and methods. In the clinic of Department of Surgery No. 2, Odessa National Medical University, from 2015 to 2020, there were operated on 57 patients for acute appendicitis with an atypical location of the appendix with the presence of concomitant cardiopulmonary pathology. All patients were divided into 2 groups. The first group consisted of 21 (36.8%) patients with an atypical location of the appendix and a high risk of cardiopulmonary failure, who underwent an open appendectomy. The second group consisted of 36 (63.2%) patients with an atypical location of the appendix and a high risk of cardiopulmonary failure, who underwent laparoscopic appendectomy. The procedure was performed according to two methods: with the imposition of pneumoperitoneum in 24 (42.2%) patients and in 12 (21%) patients with the imposition of laparolifting, due to severe cardiopulmonary pathology.
Results. Postoperative complications in group 2 were less than in patients in group 1. Average stay in the hospital of patients of the second group, after laparoscopic appendectomy, was 4.9 ± 2.35 days. In patients of the first group, with open appendectomy – 10.6 ± 5.1 days. After minimally invasive interventions, patients were in the hospital on average 5 days less than patients who underwent "open" appendectomy.
Conclusions. The use of laparoscopic and video-assisted approaches, in an atypical location of appendicitis, can reduce the incidence of postoperative complications and deaths, which generally improves the results of the treatment.
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