COMMENTARY

Transgastric Appendectomy in a Small Group of Patients

Albert B. Lowenfels, MD

Disclosures

August 09, 2013

Transgastric Appendicectomy

Kaehler G, Schoenberg MB, Kienle P, Post S, Magdeburg R
Br J Surg. 2013;100:911-915

Summary

Will transgastric appendectomy become an acceptable method for the treatment of appendicitis? The authors described their experience in the management of 15 patients with this common surgical disease. The procedures were performed using a sterilized standard gastric endoscope and a single umbilical incision for the insertion of a trocar. All 15 patients had acute appendicitis, and a transgastric appendectomy was performed successfully in 14 patients, although 2 patients required an additional standard laparoscopic procedure to drain postoperative pelvic abscesses. The hospital length of stay was about the same as with either open or laparoscopic appendectomy.

Viewpoint

Will natural orifice transluminal endoscopic surgery become the standard method for the surgical management of appendicitis? Does it offer any marked improvement over classical open appendectomy or laparoscopic appendectomy? This report proves that transgastric appendectomy is technically possible and that the end result resembles results from either of the standard surgical approaches. Of the 111 patients who were offered the choice of a transgastric operation or a traditional procedure, only 15 (about 10%) selected the transgastric approach. From the viewpoint of the surgeon, this procedure may be feasible for less complicated cases of appendicitis but less satisfactory for patients with severe inflammation. Furthermore, the training period required to learn to do the procedure safely may be longer than for conventional surgery. It seems unlikely that transgastric appendectomy will rapidly replace the conventional laparoscopic approach.

Abstract

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