A new study suggests that surgery for appendicitis that uses a pinhole incision through the navel may be a feasible alternative to traditional appendectomies. Published early online 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. DOI:10.1002/bjs.9115