Advantages of the laparoscopic surgery in children - Forum

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Schom

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#31 »

I kind of agree with this, that is, if I think the patient probably has appendicitis, I recommend lap appy on obese patients. I give moderate sized patients a choice of lap or open appy, and I generally advise thin patients to have open appy (less total incision, just as quick back to work, definitely less time). I do, though, take out the appendix incidentally if I am operating for presumed (possible) appendicitis. (I dictate it this way, that is, if the patient has mesenteric adenitis, I dictate it as incidental appy.) If I do a diagnostic laparoscopy for female pelvic pain, I do a lap incidental appy (through the single umbilical incision) if I possibly can. I also willingly do lap incidental appys on any lap chole or lap hyster patient that requests one.


Grandpa Phil

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#32 »

It is interesting that in any country (well, at least in the US and Israel) almost all candidates for the board of surgery exam can describe how to do a whipple in minute detail, yet many of them do not know how to manage ingrown toe-nails. I think that appendectomies are very important, and in all fairness, how you manage your thyroid cancer would probably make little difference to the outcome, and there is really no good answer to your problem, since the number of such cases is exceedingly small (occult primray with mets) , and therefore all data is anecdotal at best.

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Lady Surgeon

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#33 »

I think the discussion was indeed fruitful. Although some of us hold strong opinions, it would appear that in cases of diagnostic uncertainty (where a scope has already been inserted) and in instances of obesity, but arguably NOT in our 5 yr old child, unless of course we are doing it ourselves, God forbid, that lap/appy is a reasonable if not particularly cost effective method of proceeding with a surgical predicament. Here endeth the first lesson?

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Turkish surgeon

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#34 »

I cannot agree more with you, I had similar experience with my cousin when he was 11, my uncle phoned me and asked me to come and see him re "vomiting and feeling unwell". After examining him, I was convinced that he had appendx, and felt that I could not operate because of the emotional issue. The biggest problem was explaining, my reasons of referring him to another surgeon, to my family. They still believe that I cannot do appendectomies!?

सर्जन

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#35 »

There are only reasons for not doing it. It increaseses wound infection rate, increases(albeit marginally) M&M.

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Loit

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#36 »

I remember from my reading as a resident that the lifetime risk of appendicitis was high enough to justify incidental appendectomy in people under the age of 40. Have recent statistics changed this?

Antibiotic

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#37 »

Wednesday (a 5 case day), I got to do a lap appy on a fairly obese young male that I did a lap chole on within past year. He, his referring person, his family and I all wished I had done an incidental lap appy when I did his lap chole. (He did have appendicitis, WBC 23,000, luckily not ruptured.)

The best surgeon

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#38 »

Paraphrasimg it I recall having a car accident last week. My wife and I all wished I had bought a bigger and safer car last year. (I had a real accident, paid 23.000 $ for the repair, luckily I was not injured). The moral of my story is that your justification for APPY IN PASSING is not scientififcally tronger than mine.

forceps

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#39 »

But if you had bought a bigger and safer car, you still would probably have had the accident, you just would have been less likely to get hurt.

More seriously, though, the last time I remember reading a journal article about incidental appy (from the pre-lap appy days, of course), incidental appys were indicated in anyone under 80 in otherwise good health who was tolerating their operation adequately, if you didn't have to extend the incision or significantly increase the operative time. My conclusion from this is that incidental lap appy is equally as indicated in the under 80 group who are in good health otherwise, tolerating their operation reasonably well and if you don't have to make another trocar hole and if you can do an incidental lap appy quickly.

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Treatment guru

Re: Advantages of the laparoscopic surgery in children - Ärzteforum

Post#40 »

It's one thing to do an incidental appendectomy on an open case, where there is nothing that could really go wrong with the technical aspect of the case; it's something else to add an incidental appenectomy to a laparoscopic case, where there is a chance that something might happen that would necessitate an open procedure. How would you explain to the patient and family that you had to convert to open surgery to fix a problem that developed while doing something you had no real business doing in the first place?

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