Ahmet Gökhan GÜLER, Mehmet Fatih YAZAR, Ali Erdal KARAKAYA, Ahmet Burak DOĞAN

Çocuklarda Laparoskopik Apendektomiden Açık Cerrahiye Geçiş Nedenleri: İlk 100 Vaka Deneyimİ

Amaç: Bu çalışmanın amacı, öğrenme eğrisi sürecinde kliniğimizin Laparoskopik Apendektomi sonuçlarına göre,dönüşümün nedenlerini literatür ışığında tartışmak ve gereksiz açık prosedüre dönüşümü azaltmaktır. Yöntemler: Eylül 2014-Ağustos 2019 tarihleri arasında kliniğimizde akut apandisit tanısı ile laparoskopik apendektomiyapılan 100 hasta retrospektif olarak incelendi. Laparoskopik apendektomi yapılan hastalar yaş, cinsiyet, lökosit sayımı(WBC), cerrahi bulgular (apendiksin yeri, perforasyon durumu, peritonit) açısından değerlendirildi. Hastalara iki port ilegirilerek laparoskopi yapıldı. Bulgular: Laparoskopik apendektomi yapılan 63’ ü erkek 100 hastanın yaş ortalaması 10.86 ± 3.78 yaş idi. Dokuz hastadalaparoskopik işlemden açık işleme dönüldü. Hastaların WBC oranı dönüştürülmüş işlemlerde anlamlı olarak dahayüksekti. Açık apendektomiye dönüştürülen 3 hastada apendiks retroçekal yerleşimli idi. 2 hasta retroçekal apendiksinyanı sıra diffüz peritonit, 3 hastada ise yaygın peritonit vardı. Bir hastada kontrol edilemeyen kanama nedeniyle açığageçildi. Sonuç: Çocuk Cerrahisi kliniklerinde laparoskopik apendektomi kullanımı artmıştır ve açık prosedüre dönüşümüetkileyen bazı faktörler vardır. Açığa dönüştürülen prosedürlerde WBC oranı önemli ölçüde daha yüksekti. Çalışmasonuçları bu açıdan incelendiğinde, apendiksin retroçekal yerleşimi, perforasyon ve yaygın peritonit laparotomikprosedürden açık prosedüre dönüşüm için en önemli bağımsız göstergelerdir.

The reasons for conversion from laparoscopic appendectomy to opensurgery in children: the first experience on 100 cases in a single

Objective: This study aimed to discuss the reasons for conversion in light of the literature and reduce any unnecessary conversion to open procedure, according to our clinic's results during the learning curve.Methods: A retrospective review was performed on 100 patients who had a laparoscopic appendectomy in our clinic between September 2014 and August 2019. The patients who had a laparoscopic appendectomy were evaluated for conversion to open procedure by reviewing the age, gender, white blood cell count (WBC), and surgical findings (location of the appendix, perforation status, peritonitis). Laparoscopy was performed through two ports. Results: The age average of 100 patients, including 63 males who have undergone a laparoscopic appendectomy, was 10.86 ± 3.78 years. The laparoscopic technique was converted to open in nine children. WBC ratio of the patients was significantly higher in converted procedures. Among the procedures converted to open appendectomy, three patients presented retrocecal appendix placement; two patients presented retrocecal placement and perforation and diffuse peritonitis; three patients presented perforation and diffuse peritonitis, and one patient presented uncontrolled bleeding. Conclusion: The use of laparoscopic appendectomy has just increased in Pediatric Surgery clinics along with some factors that affect the conversion to open procedure. WBC ratio was significantly higher in converted procedures. When study results are reviewed from this perspective, perforation, diffuse peritonitis, and the appendix's retrocecal location are the most significant independent indicators for conversion from laparotomic procedure to open procedure.

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