[Video laparoscopic appendectomy. Our experience].

OBJECTIVE: Personal experience with the use of VL in the treatment of acute appendicitis (AA) is reported. The main advantage of this method is its high diagnostic reliability. SETTING: Chirurgia Generale I. Dipartimento di Discipline Chirurgiche e Anatomiche. Policlinico Università Palermo. SUBJECTS: The VL method has been used in 36 patients with diagnosis of suspect acute appendicitis. INTERVENTIONS: In the cases in which the diagnosis has been confirmed, a VL appendectomy with endoabdominal technique according to Semm has been performed in 23 cases, and an assisted VL appendectomy, trough a minimal and guided laparotomy, in 8 cases. In order to avoid vascular and visceral injuries, an "open" laparoscopy technique is always used. RESULTS: The diagnosis has been confirmed in 31 cases, 21 women and 10 men. The diagnosis has not been confirmed in 5 cases, a man of 74 years with sigmoidal diverticulitis and 4 women with terminal ileitis in a case, torsion of right ovarian cyst in another and, finally, pelvic inflammatory disease in 2. CONCLUSIONS: From this brief experience it is evident the diagnostic advantage of VL particularly in the female and in elderly patients. Other advantages of this method are the excellent aesthetic result, light postoperative pain, the rapid functional resumption, the small impact of adherences, wound infection, and incisional hernia, and the lower cost, when staplers are not used. The disadvantages are the extension of the operative time, using the "open" laparoscopy technique, and the difficulty to find Meckel diverticulum.