Laparoscopic Appendectomy

The irrigation of the intra-abdominal cavity with copious amounts of normal saline under direct vision has decreased the number of post-operative septic episodes or postoperative intra-abdominal abscesses. However, several patients were readmitted with severe abdominal pain and sepsis within ten days after this procedure. Our protocol mandates the following in this clinical setting: 1) Admission to the surgical service, 2) IV antibiotics (Cefizox™ and Flagyl™), 3) Computerized Tomography scan (preferably Spiral) of the abdomen and pelvis, 4) If no localized fluid collection or abscess can be demonstrated on the CT, the patients will continued IV antibiotics only, 5) If an abscess is demonstrated, the patient will undergo a CT guided drainage versus a laparoscopic drainage.

Prior to the introduction of the ENDOCATCH™ instrument,  a significant number of trocar site infections was reported by our surgical team. These incisions were opened at the bedside and drained.

With the use of  the ENDOCATCH™ instrument to remove the infected specimen from the intra-abdominal cavity, we only reported one wound infection. The irrigation of the trocar site with normal saline at the end of the procedure should also always be done when gross contamination occurred.

In patients with severe, perforated appendicitis, the appendix may be difficult to locate. In this clinical settings, the cecum should be well visualized, dissected and exposed. The base of the appendix is at the confluence of the colic tenias. Persistence is key.

In some cases of severe, acute, necrotizing appendicitis the base of the appendix may not be suitable for transection with a MULTIFIRE ENDOGIA™. It may be technically easier and safer to perform a [partial or full] "cecectomy" using the same stapling device.