RESUMEN
BACKGROUND: The laparoscopic approach for suspected appendicitis is increasingly gaining acceptance. Nevertheless, the discussion on its safety, efficacy, indications, and diagnostic accuracy remains open. METHODS: During the decade 1993-2003, 1026 patients with suspected appendicitis were approached by laparoscopy. Sixty-three patients (6.1%) had chronic recurrent symptoms. Data were collected retrospectively and analyzed. There were 587 female and 439 male patients. Fertile women were compared to all other patients with respect to the diagnostic accuracy of laparoscopy. RESULTS: Conversion rate was 0.55%. Median operating time was 26 minutes. Overall complication rate was 5.7%, consisting mostly of minor complications. There were no major intraoperative complications. Wound infections and intra-abdominal abscesses were reviewed separately and were 1.1% and 0%, respectively. Diagnosis could be established via laparoscopy in 89% of all patients, 85.4% of fertile women, and 93.1% of patients except fertile women. A median of 4 minor analgesics and 2 narcotics were required after surgery. The median time until bowel movements, intake of solid food, and the median length of hospital stay were 24, 48, and 30 hours, respectively. Patients returned to normal activity after a median of 7 days. There was no mortality. There was 1 reoperation. Follow-up lasted 4 weeks. CONCLUSION: Laparoscopic appendectomy is a well-justified procedure in the treatment of acute and chronic appendicitis. If there is enough experience, patients can profit from a higher diagnostic accuracy, quicker return of bowel habits, less postoperative pain, shorter hospital stay, and a faster return to normal activities than is reported for the open procedure. Especially, fertile women can profit from these advantages. This abstract has been presented as a poster in the SAGES Conference 2004.
Asunto(s)
Apendicectomía , Apendicitis/cirugía , Laparoscopía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Apendicitis/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Resuscitation of hemorrhagic shock is associated with tissue injury. The effect of hypoxemia during resuscitation was investigated. METHODS: Shock was induced by withdrawing blood to mean arterial pressure (MAP) 40 mm Hg and maintained for 60 minutes in 25 Wistar rats. Animals were randomly divided to receive either normoxemic (controls, FiO2 = 21%, n = 14) or hypoxemic (HypRes, FiO2 = 12%, n = 11) resuscitation by re-infusing their shed blood. Outcome was assessed through hemodynamic and inflammatory parameters. Another nine rats served to correlate different FiO2 to the corresponding PaO2. RESULTS: At 60 minutes of resuscitation HypRes had higher MAP than control animals (p = 0.008). The respective median (range) malondialdehyde and TNF-alpha levels was 1.7 (1-2.1) versus 3.1 (2.4-4.3) micromol/L, (p = 0.02) and 0 versus 5.8 (0-5.8) pg/mL, (p = 0.025). Glutathione, endotoxin, interferon-gamma, and nitric oxide values were similar between groups. FiO2 of 12% induced only a mild hypoxemia (PaO2 approximately 80 mm Hg). CONCLUSIONS: Even mild hypoxemia during resuscitation of shock leads to effective hemodynamic stabilization.