2413 Appendiceal Endometriosis: Laparoscopic Endoloop Appendectomy

Abstract

Video Objective To demonstrate the surgical steps of the laparoscopic appendectomy for a deep endometriosis nodule using endoloops. Setting Endometriosis affect between 6%-10% of patients in reproductive age. Furthermore, gastrointestinal tract is involved between 3% to 34% of the cases, and specifically the appendix is invaded in about 2.8% to 5%. Appendiceal endometriosis encompass a wide range of manifestations including acute and chronic appendicitis, cyclic lower quadrant pain, melena, rectorrhagia, cecal intusception and intestinal perforation.Laparoscopic appendectomy is widely performed in nowadays and include several techniques as stapler, endoloops and hand-made loops. Specific steps of the procedure must be know and understand. Here we present a laparoscopic appendectomy using 2 base endoloops in a 38 years old patient with clinical history of dysmenorhheia, dayspareunia and cyclic rectorhhagia. Pelvic Ultrasound and MRI were negative for appendiceal endometriosis. Interventions A completely laparoscopic approach to the pelvic and bowel endometriosis was performed. Under general anesthesia, the patient was placed in 0 degrees dorsal decubitus with her arms alongside her body. Operative set-up include 15 mmhg pneumoperitoneum created using the closed-Veress technique and four trocars: a 10-mm trocar at the umbilicus for a zero-degree laparoscope; a 5-mm trocar in the right-iliac fossa; a 5-mm trocar in left-iliac fossa; and a 12-mm trocar in the suprapubic area. Using blunt and sharp dissection with cold scissors, bipolar grasper and ultrasonic energy, complete resection of pelvic deep endometriosis was done followed by appendectomy using 2 endo-loops (Vicryl 2-0) at their base. Specimen extraction was done using an endobag and fascial defect was closed by delayed-absorbable 1-0 . Patient was discharge in the second day postoperative without any complications. Conclusion Appendectomy is a part of the global treatment of endometriosis and must be removed when involved.Laparoscopic resection using endoloops is feasible, safe and effective.