Evidence based guidelines for laparoscopic appendectomy: results of a consensus conference: LTP79


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Abstract

Aim:Laparoscopic appendectomy is, today, widely disseminated. ACOI (Association of Italian Hospital Surgeons) has organized a Consensus Conference on the argument.Method:A panel of 21 experienced surgeons were selected and interviewed; a subsequent discussion using the Delphi method was submitted to the evaluation of an audience of surgeons. Statements were formulated and a level of evidence assigned. The entireprocess was revised by two external and one internal reviewers.Results:Consensus development guidelines regarding diagnostic pathway (mainly clinical, gynaecological exam andpregnancy test recommended, computed tomography only as a second choice exam, C-reactiveprotein only in trials), diagnostic laparoscopy (recommended as final diagnostic act, after a period of active observation in doubtful cases), indications (women, men, obese and elderly), behaviour in case of innocent appendix (preservation if concomitant pathology), conversion (never mandatory, adequate laparotomy suggested), technical aspects (proper triangulation, bipolar coagulation for the mesoappendix, loop for the stump, stapler recommended for gangrene, mandatoryprotection of the abdominal wall, thorough peritoneal washing in peritonitis, drainage not needed), learning curve (20 cases for the beginner,previous laparoscopic experience important).Conclusion:Some questions remain unsolved (pregnancy, removal of an innocent appendix in case of absence of other diseases) due to the lack of participated evidence.

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