Diagnostic Laparoscopy through a Right Lower Abdominal Incision in Suspected

Suh, Hae Hyeon

Abstract

Recently, diagnostic laparoscopy has proved useful in reproductive women and patients with suspicious appendicitis. Diagnostic laparoscopy is usually performed through an incision just above or below the umbilicus. But the periumbilical incision of laparoscopy sometimes causes unnecessary skin incision when converted to open conventional appendicectomy and incisional hernia through the periumbilical port site. To prevent these disadvantages I have performed diagnostic laparoscopy through a right lower abdominal incision in suspected appendicitis. A transverse skin incision of 1.5~2.0 cm in length is made in the right lower abdomen. Using the open method, a cannula is inserted into the peritoneal cavity. After establishing the pneumoperitoneum, the whole peritoneal cavity can be carefully observed by tilting the operation table. According to the laparoscopic findings, appendicectomy and/or other operations may be performed with the laparoscopic or conventional method. I have used this technique in 39 patients (17 men and 22 women; age range 6 to 69 years). Pathologic findings of removed appendices were 2 normal; 17 catarrhal; 13 suppurative; and 7 gangrenous. The appendix was not visualized in 4 patients; but, were diagnosed to be appendicitis according to the findings of neighboring structures. There was a false negative which was a focal appendicitis accompanied with salphingitis. But there was no false positive. Associated diseases were gall stone (3 cases), uterine myoma (2 cases), an inguinal hernia, an intestinal adhesion, an ulcerative colitis, and a Crohn's disease. In conclusion, this technique can be an alternative route when the periumbilical route is difficult to approach due to previous incisional scars. Compared to periumbilical laparoscopy: (1) it is technically easier because it is familiar to the general surgeon; (2) it is more effective for esthetic purposes because it does not leave an unnecessary skin incision; and (3) it can prevent incisional hemia.