Apendicectomía: Incision Transumbilical Escalonada Vs Incision Rockey - Davis (Transversa) en Apendicitis Aguda

Abstract

Nowadays look for small incisions either because of esthetics or due to the surgeon's skill. Objective: To compare
the staged transumbilical approach versus conventional Rockey-Davis technique for appendectomy in patients
with acute and / or complicated appendicitis. Material and methods: a retrospective, descriptive and cross-sectional
study, at Hospital Maria Auxiliadora (HMA) in the period 2011 to 2013. Student’s t-test of independent samples was performed using the SPSS V21 statistical program, in order to define whether there is a significant difference in the times of anesthesia, surgical times and hospital stays of patients operated on for appendicitis using the Rockey Davis technique compared to the Transumbilical Technique. Results: 356 patients, 61.20% (n = 218) were males and 38.80% (n = 138) females who underwent appendectomy, 44.94% (n = 160) with the conventional transverse or Rockey-Davis technique, and 55.05% (n = 196) with the staggered transumbilical technique. The Anesthesia time for Rockey Davis was on average 52.13 minutes whereas for Transumbilical it was 64.33 minutes on average- the Levene contrast test (p<0.50) for variances is different showing significant differences. The surgical time for Rockey Davis was on average 40.37 minutes whereas for Transumbilical it was 52.48 minutes on average- then the Levene contrast test (p> 0.50) tells us that the variances are the same showing a significant difference between the average surgical times. The days of stay for Rockey Davis were on average 3.47 days whereas for Transumbilical it was 3.87 days, then the Levene contrast test (p> 0.50) tells us that the variances are the same showing no significant differences. The time of evolution of the disease was from 6 to 20 hours for 30% (n = 106), 21 to 40 hours 42.97% (n = 153), from 41 to 60 hours 17.41% (n =62) and in patients from 61 to more hours a percentage of 9% (n = 35); with 21 to 40 hours being the most frequent. All patients were given pre and post-operative antibiotics; patients received cephazoline 8.42%, ceftriaxone 7.86%, ceftriaxone + metronidazole 21.62%, ciprofloxacin + metronidazole 15.44%, ciprofloxacin + clindamycin 28%, clindamycin + amikacin 46.38%; according to the time of evolution of the disease and the intraoperative findings. Conclusions when comparing both techniques in relation to the time of anesthesia and surgery, significant differences are observed which do not happen with the hospital stay. Recommendations: Despite finding those differences that can be improved with practice It is recommended to perform the transumbilical surgical approach for appendectomy in acute and / or complicated appendicitis as it is safe, easy to perform and offers superior aesthetic results to other approaches.