La apendicitis aguda es una de las primeras causas de abdomen agudo quirúrgico en la mayor parte de los hospitales en México. La perforación del apéndice es una complicación frecuentemente asociada al tiempo de evolución. Objetivo: Describir la técnica con punto transfi ctivo seromuscular para el manejo del muñón en apendicitis con perforación o necrosis del tercio proximal. Material y métodos: Se ha diseñado una técnica que consiste en colocación de un punto transfi ctivo seromuscular en un solo sitio o dos de la base apendicular proximal a la zona de necrosis o perforación. Se diseñó un estudio de cohorte sobre una base de datos prospectiva en la que se evaluaron pacientes con perforación o necrosis de la base del apéndice. Resultados: Se realizaron 20 apendicetomías, de las cuales 11 fueron por vía laparoscópica, nueve casos con técnica abierta con manejo del muñón con colocación de punto de anclaje transfi ctivo seromuscular en la base apendicular. En ningún caso se desarrolló complicación postquirúrgica. Conclusiones: A pesar de los dispositivos modernos para el cierre del muñón apendicular, aún es difícil el cierre de perforaciones en la base del ciego. En apendicitis complicada con perforación a nivel del tercio proximal, la técnica que se utilizó para el abordaje del muñón es una opción efi caz y segura.
Introduction Appendectomy is one of the most frequent emergency surgical procedures, currently with a preference for laparoscopic management worldwide. Objective To report a new laparoscopic appendectomy technique and its results. Material and methods Cohort study of patients with a diagnosis of appendicitis who are managed laparoscopically. In a total 1063 patients, 148 were operated on with the Zaragoza technique during the period from January 2002 to December 2018. The technique consists of making a window in the appendicular base between the meso and the appendicular wall, two prolene or silk sutures are placed, and the cecal appendix is cut between the two sutures, finally the mesoappendix is sectioned with a harmonic scalpel or bipolar clamp. Results From our results, we had 1.4% residual abscesses, 1.4% umbilical surgical wound infection and 0% mortality. Discussion Various laparoscopic management methods for appendectomy are reported in the literature, with a wide range in the results. We have obtained good results in patients subjected to our technique. Conclusions The Zaragoza technique for laparoscopic appendectomy is an effective and safe option that prevents excessive manipulation of the inflamed appendix and is easily reproducible.
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