Resumo

PESTANA-TIRADO, Ramiro Alberto  e  MORENO BALLESTEROS, Luis Ramón. Transumbilical appendectomy: A novel surgical approach. rev. colomb. cir. [online]. 2004, vol.19, n.1, pp.54-68. ISSN 2011-7582.

Acute appendicitisis an inflammatory process of the cecal appendix and is the most common presentation of acute abdomen and the most frequent cause of surgical intervention in the emergency services. Its annual incidence is around 1.33 and 0.99 per 1.000 in habitants for males and females respectively. Since Reginald Fitz introduced the term appendicitis and recommended the surgical extirpation of the appendix in 1886, surgeons have adopted different approaches in regard to the incision in over abdominal wall. Thus, McBurney in 1889 described the incision that took his name; other surgeons, such as Battle, Jalaguer, Kanmerer and Lennander proposed the right pararectal access in 1897; J.W. Elliot promoted a transverse incision over the right lower quadrant, wich was modified by Rockey and Davis en 1905; this incision carries today the eponym of these authors. The right paramedian and the midline intraumbilical incisions, as well as the laparoscopic approach have also been utilized. This work is based on the current concepts minimally of invasive surgery, the anatomy and physiology of the abdominal wall, the experience with subxiphoid open cholecystectomy, and the mobility of the cecum and appendix. We hereby present the experience with appendicctomy by the umbilical access at Hospital Infantil Napoleón Franco Pareja, Hospital Universitario and Clínica Central, in the City of Cartagena de Indias, Colombia, in the period February 1999 to February 2003. This type appendicectomy was performed in 197 patients that presented with acute appendicitis; the umbilical approach developed by the authors, consisting in the resection over umbilicus, wich we have named umbilical appendicectomy. This surgical technique complies with Maingot´s principles of accessibility, extensibility and security for a surgical incision. It is a valid alternative for the skilled surgeon for the correction of acute appendicitis, that leaves the abdominal wall free of anatomic or physiologic sequelae and with an excellent cosmetic result.

Palavras-chave : gastroesophageal reflux disease; Nissen fundoplication; anterior fundoplication; systematic review; results and postoperative sequelae.

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