A videolaparoscopia na apendicite aguda na mulher em idade fértil

Campolina, Cláudio de Oliveira Chiari; Alves, Antônio Sérgio; Vieira Júnior, Álvaro; Oliveira, Cláudio Almeida de; Vianna, José Luiz Campelo de Mello; Costa, Marcos Eduardo Valadares Meirelles M.

doi:10.1590/S0100-69911998000100008

Resumos

O diagnóstico de apendicite aguda na mulher em idade fértil é um desafio para o cirurgião devido ao alto índice de explorações cirúrgicas negativas. O objetivo deste trabalho foi estabelecer um índice de probabilidade diagnóstica e o valor da videolaparoscopia nestes casos. Foram analisadas, prospectivamente, 34 mulheres em idade fértil referendadas para o serviço com diagnóstico de apendicite aguda. As pacientes foram submetidas à videolaparoscopia de urgência, e o tratamento cirúrgico, quando indicado, foi realizado por videolaparoscopia sempre que possível. Entre as 34 pacientes, 17 apresentaram apendicite aguda à videolaparoscopia, sendo que 15 delas foram operadas por esta via. As 17 pacientes que apresentaram outro diagnóstico à videolaparoscopia não necessitaram de qualquer tratamento cirúrgico em 13 casos, sendo que quatro pacientes foram submetidas a operação por via aberta. O quadro clínico foi medido por um índice de probabilidade para apendicite aguda, e os resultados videolaparoscópicos foram relacionados a este índice. A conclusão é que a videolaparoscopia é um instrumento importante na abordagem propedêutica e terapêutica do abdome agudo da mulher em idade fértil, possibilitando uma maior precisão diagnóstica nestes casos e evitando laparotomias não terapêuticas.

Abdome agudo; Videolaparoscopia; Apendicite aguda

In fertile women the diagnosis of acute appendicitis is a challenge for the surgeon. A negative surgical exploration of the abdomen is not uncommon. The purpose of our study was two fold: to stablish a probability diagnostic index of acute abdomenfor fertile women and the value of the videolaparoscopy of the abdomen for the diagnosis and therapeutic in this group of patients. Thirty-four women with clinical and laboratory data suggesting acute appendicitis were divided into three groups according to the probability of having the disease: high, medium and low probability. Following that, all thirty-four patients were submitted to videolaparoscopic evaluation of the abdomen. If necessary, an appendectomy was carried out with the same procedure. According to our probability index, we observed: ten patients were classified as being low probability, twelve as being medium probability and twelve as being high probability. The results showed that in the low probability group only two patients (20%) had confirmed appendicitis. In the medium probability group, six patients (50%) had confirmed acute appendicitis. In the high probability group, nine patients (75%) had the diagnosis confirmed. From our study we concluded that fertile women who fit the high and medium probability group should have an immediate laparoscopic evaluation of the abdomen. Fertile women who fit the low probability group, will not be jeopardized if a period of clinical observation is undertaken.

Acute abdome; Videolaparoscopy; Acute appendicitis

ARTIGOS ORIGINAIS

A videolaparoscopia na apendicite aguda na mulher em idade fértil

The videolaparoscopy in acute appendicitis in woman of childbearing age

Cláudio de Oliveira Chiari Campolina^I; Antônio Sérgio Alves, ACBC-MG^II; Álvaro Vieira Júnior^III; Cláudio Almeida de Oliveira^IV; José Luiz Campelo de Mello Vianna, ACBC-MG^V; Marcos Eduardo Valadares Meirelles M. Costa, ACBC-MG^VI

^IMédico Residente da Clínica Cirúrgica II do Hospital Felício Rocho

^IIDoutor em Cirurgia pela UFMG, Cirurgião do Hospital Felício Rocho, Professor Assistente da FCMMG

^IIICirurgião do Hospital Felício Rocho, Professor Assistente da FCMMG

^IVChefe da Clínica Cirúrgica 11 do Hospital Felício Rocho, Professor Titular do Departamento de Cirurgia da FCMMG

^VCirurgião do Hospital Felício Rocho, Professor Assistente da FCMMG

^VICirurgião do Hospital FeIício Rocho

^{Endereço para correspondência} Endereço para correspondência: Dr. Cláudio Oliveira Chiari Campolina Rua Pe. João Crisóstomo, 141/201 30535-510 - Belo Horizonte - MG

RESUMO

O diagnóstico de apendicite aguda na mulher em idade fértil é um desafio para o cirurgião devido ao alto índice de explorações cirúrgicas negativas. O objetivo deste trabalho foi estabelecer um índice de probabilidade diagnóstica e o valor da videolaparoscopia nestes casos. Foram analisadas, prospectivamente, 34 mulheres em idade fértil referendadas para o serviço com diagnóstico de apendicite aguda. As pacientes foram submetidas à videolaparoscopia de urgência, e o tratamento cirúrgico, quando indicado, foi realizado por videolaparoscopia sempre que possível. Entre as 34 pacientes, 17 apresentaram apendicite aguda à videolaparoscopia, sendo que 15 delas foram operadas por esta via. As 17 pacientes que apresentaram outro diagnóstico à videolaparoscopia não necessitaram de qualquer tratamento cirúrgico em 13 casos, sendo que quatro pacientes foram submetidas a operação por via aberta. O quadro clínico foi medido por um índice de probabilidade para apendicite aguda, e os resultados videolaparoscópicos foram relacionados a este índice. A conclusão é que a videolaparoscopia é um instrumento importante na abordagem propedêutica e terapêutica do abdome agudo da mulher em idade fértil, possibilitando uma maior precisão diagnóstica nestes casos e evitando laparotomias não terapêuticas.

Unitermos: Abdome agudo; Videolaparoscopia; Apendicite aguda.

ABSTRACT

In fertile women the diagnosis of acute appendicitis is a challenge for the surgeon. A negative surgical exploration of the abdomen is not uncommon. The purpose of our study was two fold: to stablish a probability diagnostic index of acute abdomenfor fertile women and the value of the videolaparoscopy of the abdomen for the diagnosis and therapeutic in this group of patients. Thirty-four women with clinical and laboratory data suggesting acute appendicitis were divided into three groups according to the probability of having the disease: high, medium and low probability. Following that, all thirty-four patients were submitted to videolaparoscopic evaluation of the abdomen. If necessary, an appendectomy was carried out with the same procedure. According to our probability index, we observed: ten patients were classified as being low probability, twelve as being medium probability and twelve as being high probability. The results showed that in the low probability group only two patients (20%) had confirmed appendicitis. In the medium probability group, six patients (50%) had confirmed acute appendicitis. In the high probability group, nine patients (75%) had the diagnosis confirmed. From our study we concluded that fertile women who fit the high and medium probability group should have an immediate laparoscopic evaluation of the abdomen. Fertile women who fit the low probability group, will not be jeopardized if a period of clinical observation is undertaken.

Key words: Acute abdome; Videolaparoscopy; Acute appendicitis.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 10/3/97

Aceito para publicação em 9/1 0/97

Trabalho realizado no Hospital Felício Rocho - Belo Horizonte - MG.

1. Dunn EI, Moore EE, Elerding SC, et al. The unnecessary laparotomy for appendicitis - Can it be decreased? Am Surg 1982;48:320-323.
2. Deutsch AA, Zelikovsly A, Reiss R. Laparoscopy in the prevention of unnecessary appendicectomies: a prospective study. Br J Surg 1982; 69:336-337.
3. Nakhgevany KB, Clarke LE. Acute appendicitis in women of child- bearing age. Arch Surg 1986;121:1.053-1.055.
4. Spirtos NM, Eisenkop SM, Spirtos TW, et al. Laparoscopy - A diagnostic aid in cases of suspected appendicitis. Am J Obstet Gynecol 1987;156:90-94.
5. Paterson-Brown S. Emergency laparoscopy surgery. Br J Surg 1993; 80:279-283.
6. Whitworth CM, Whitworth PW, Sanfillipo J, et al. Value of diagnostic laparoscopy in young women with possible appendicitis. Surg Gynecol Obstet 1988;167:187-190.
7. Olsen JB, Myrén CJ, Haahr PE. Randomized study of the value of laparoscopy before appendicectomy. Br J Surg 1993;80:922-923.
8. Navez B, Cambier E, Richir C, et al. Laparoscopy for management of nontraumatic acute abdomen. World J Surg 1995; 19:382-387.
9. Rodrigues FCM, Rahal F, Soldá SC, et al. Laparoscopia diagnóstica no doente de alto risco. Rev Col Bras Cir 1995;22:79-82.
10. McAnena OJ, Austin O, Hederman WP, et al. Laparoscopic versus open appendectomy: a prospective evaluarion. Br J Surg 1992; 79: 818-820.
11. Frazee RC, Roberts JW, Symmonds RE, et al. A prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg 1994;219:725-731.
12. Ortega AE, Hunter JG, Peters JH, et al. A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Am J Surg 1995;169:208-213.
13. Martin LC, Puente I, Sosa JL, et al. Open versus laparoscopic appendectomy - A prospective randomized comparison. Ann Surg 1995;222:256-262.
14. Apelgren KN, Cowan BD, Metcalf Am, et al. Laparoscopic appendectomy and the management of gynecologic pathologic conditions found at laparoscopy for presumed appendicitis. Surg Clin North Am 1996;76:469-482.

Endereço para correspondência:

Dr. Cláudio Oliveira Chiari Campolina

Rua Pe. João Crisóstomo, 141/201

30535-510 - Belo Horizonte - MG

Datas de Publicação

Publicação nesta coleção
27 Jul 2010
Data do Fascículo
Fev 1998

Histórico

Aceito
09 Out 1997
Recebido
10 Mar 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Dunn EI, Moore EE, Elerding SC, et al. The unnecessary laparotomy for appendicitis - Can it be decreased? Am Surg 1982;48:320-323.

[2] 2. Deutsch AA, Zelikovsly A, Reiss R. Laparoscopy in the prevention of unnecessary appendicectomies: a prospective study. Br J Surg 1982; 69:336-337.

[3] 3. Nakhgevany KB, Clarke LE. Acute appendicitis in women of child- bearing age. Arch Surg 1986;121:1.053-1.055.

[4] 4. Spirtos NM, Eisenkop SM, Spirtos TW, et al. Laparoscopy - A diagnostic aid in cases of suspected appendicitis. Am J Obstet Gynecol 1987;156:90-94.

[5] 5. Paterson-Brown S. Emergency laparoscopy surgery. Br J Surg 1993; 80:279-283.

[6] 6. Whitworth CM, Whitworth PW, Sanfillipo J, et al. Value of diagnostic laparoscopy in young women with possible appendicitis. Surg Gynecol Obstet 1988;167:187-190.

[7] 7. Olsen JB, Myrén CJ, Haahr PE. Randomized study of the value of laparoscopy before appendicectomy. Br J Surg 1993;80:922-923.

[8] 8. Navez B, Cambier E, Richir C, et al. Laparoscopy for management of nontraumatic acute abdomen. World J Surg 1995; 19:382-387.

[9] 9. Rodrigues FCM, Rahal F, Soldá SC, et al. Laparoscopia diagnóstica no doente de alto risco. Rev Col Bras Cir 1995;22:79-82.

[10] 10. McAnena OJ, Austin O, Hederman WP, et al. Laparoscopic versus open appendectomy: a prospective evaluarion. Br J Surg 1992; 79: 818-820.

[11] 11. Frazee RC, Roberts JW, Symmonds RE, et al. A prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg 1994;219:725-731.

[12] 12. Ortega AE, Hunter JG, Peters JH, et al. A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Am J Surg 1995;169:208-213.

[13] 13. Martin LC, Puente I, Sosa JL, et al. Open versus laparoscopic appendectomy - A prospective randomized comparison. Ann Surg 1995;222:256-262.

[14] 14. Apelgren KN, Cowan BD, Metcalf Am, et al. Laparoscopic appendectomy and the management of gynecologic pathologic conditions found at laparoscopy for presumed appendicitis. Surg Clin North Am 1996;76:469-482.

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