Appendicectomy via Small Navel Incision Gets High Marks

Steven Fox

April 11, 2013

Transgastric appendicectomy via a small incision at the navel may be a viable alternative to traditional laparoscopic surgery in uncomplicated cases, according to results from a preliminary study of 14 patients who underwent the procedure in Germany.

The study was published online April 11 in the British Journal of Surgery.

"Experimental studies and small anecdotal reports have documented the potential and feasibility of transgastric appendicectomy," write Georg Kaehler, MD, from the University of Heidelberg's University Medical Centre, Mannheim, Germany, and colleagues. "This paper reports the results of the new technique in a selected group of patients."

During the period from April 2010 through April 2011, 15 patients who had been diagnosed with acute appendicitis at the hospital and who presented with what were initially deemed uncomplicated cases underwent the new procedure. "Patients with suspected perforated appendicitis, obstruction in the upper gastrointestinal tract, previous upper abdominal operations, pregnancy, liver cirrhosis and body mass index exceeding 30 kg/m2 were excluded," the authors write.

After initiation of the procedure, 1 of the patients was converted to laparoscopic surgery because of the presence of severe inflammation and adhesions. Two of the remaining 14 patients who underwent transgastric appendicectomy had initial peritonitis and required laparoscopic lavage 4 days after surgery. Even so, the authors say no leaks were seen, either at the appendiceal stump or at the stomach.

"In this series there were no problems with gastric access," the authors write, adding, "No damage of neighbouring organs was recorded." They add that there were no remarkable clinical differences between patients who underwent transgastric appendicectomy and other patients who are managed with more conventional laparoscopic surgery.

Dr. Kaehler and colleagues concede their results are only preliminary, but they see significant potential for the new surgical approach. "Building on these promising results, further clinical investigations, including a multicentre study, are now being planned, which will hopefully prove the feasibility and safety of transgastric appendicectomy," they conclude.

Ovesco Endoscopy provided over-the-scope clips for the study. The authors have disclosed no relevant financial relationships.

Br J Surg. Published online April 11, 2013.