대한대장항문학회

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