Pinhole surgery has potential for treating appendicitis
22 April 2013
Surgery for appendicitis that uses a pinhole incision through the
navel may be a feasible alternative to traditional appendectomies,
according to a study published in the British Journal of
Surgery. The findings indicate that larger studies to test the
potential of the procedure are warranted.
An experimental, minimally invasive, and scarless surgical
procedure for appendicitis called transgastric appendicectomy avoids
the use of external incisions and causes less pain than traditional
appendectomies. Through the insertion of a needle, an endoscope is
passed through the stomach into the abdominal cavity.
“Surgeons and their patients had good experiences with surgery by
pinholes beginning in the 1990s, and there is interest in continuing
this development to avoid incisions in the abdominal wall completely
and to obviate wound infections and incisional hernias,” said Georg
Kaehler, MD, of the University of Heidelberg’s University Medical
Centre Mannheim, in Germany. “Therefore we used flexible tubes
called gastroscopes to get through the stomach into the abdominal
cavity and to perform surgical operations there.”
Dr Kaehler and his colleagues performed transgastric
appendicectomy in a group of 14 patients with uncomplicated
appendicitis. Two patients with abdominal inflammation required
lavage, or cleansing treatments, four days after the procedure.
Hospital stays and postoperative complications were similar to those
of classical surgical methods for appendicitis.
These preliminary results demonstrate the potential of this
innovative procedure, particularly for appendicitis not accompanied
by generalized peritonitis; however, more information is needed on
the specific advantages and disadvantages of the approach. Dr.
Kaehler and his co-authors noted that a multicenter study is now
being planned, which will hopefully prove the feasibility and safety
of transgastric appendicectomy.
Kaehler et al. Transgastric appendicectomy. BJS.