Apendicite aguda e laparoscopia com clipagem do côto apendicular e análise intervencionista

Abstract

Hipólito Souza Monte. Dissertation presented in 28/08/2019 to the Post-Graduate Program in Clinical Pharmacology of theFederal University of Ceará, as a partial requirement to obtain the title of Master. In Clinical Pharmacology.This retrospective study analyzed 5,021 cases of laparoscopic appendicectomy for complicated and uncomplicated acute appendicitis performed by the same surgeon during the period from 2001 to 2018, observing the methods of appendiceal closure, the most used technique and its consequences. The most representative parameters for the study were: hospitalization time, operative time, incidence of wall infection, incidence of intra-abdominal abscess, need for conversion, use of antibiotic therapy, introduction of oral diet, abdominal wall intercurrences, reexploration of abdominal cavity and the most important parameter evaluated was the use of a titanium metal clip to close the appendicular stump. The following results were found: mean hospital stay time of 24.08 hours; mean operative time of 15.19 min; absence of wall infection; absence of intra-abdominal abscess; zero conversion rate; antibiotic therapy with predominance of Sulbactam with Ampicillin and Metronidazole; introduction of oral diet with an average of 4 hours postoperatively; observed two umbilical scar seromas and two abdominal wall ecchymoses/bruise; intestinal obstruction diagnosed in the 5th and 12th postoperative days, respectively, with laparoscopic re-inspection; Metallic titanium clip used in 5,006 cases. After compiling all the data, an analysis of the results was carried out with similar national and international studies in order to verify the most effective and efficient method for appendicular stump closure. After conducting the study, it was observed that in face of a clinical case of diagnosed acute appendicitis, even with a few days of evolution, the laparoscopic method should be used as the initial treatment, as the best option and to perform the closing of the cut appendicular with titanium clip.