Laparoscopic approach to mucocele of appendiceal mucinous cystadenoma: feasibility and short-term outcomes in 24 consecutive cases.

Abstract

Mucocele of the appendix is an uncommon condition where luminal distention by mucin is usually attributable to a mucinous cystadenoma. From a surgical standpoint, it is critical that the mucin-filled tumor remains intact during resection. Spillage of mucin into peritoneal cavity may otherwise lead to pseudomyxoma peritonei. Although acute appendicitis is managed successfully by laparoscopic appendectomy, the potential for rupture has fueled concerns over laparoscopic resection of appendiceal mucoceles. Our aim was to evaluate feasibility, safety, and short-term outcomes of laparoscopic resection in patients with a mucocele of appendix secondary to mucinous cystadenoma. Data collected prospectively at the Department of Surgery from October 2005 to December 2013 were reviewed, selecting all instances of preoperatively identified appendiceal mucoceles, which was confirmed as mucinous cystadenomas by histology after elective laparoscopic surgery. Patient demographics, surgical data (operative procedures and times, intraoperative complications), and short-term postoperative outcomes were analyzed retrospectively. Twenty-four consecutive patients (female 14) were studied. Mean age was 60.0years (range 42-81years). Surgical procedures included simple appendectomy (1/24, 4.2%), partial cecectomy (15/24, 62.5%), and ileocecal resection (8/24, 33.3%). Mean operative time was 108.5min (range 40-205min). No intraoperative spillage of mucin occurred due to inadvertent rupture of tumor. Resection margins uniformly were negative for tumor. Mean maximal length and diameter of tumors were 7.9cm (range 3.0-20.0cm) and 3.2cm (range 1.0-7.5cm), respectively. One patient (4.2%) suffered postoperative morbidity (wound infection). A laparoscopic approach proved feasible and safe for surgical management of appendiceal mucocele due to mucinous cystadenoma. However, long-term follow-up is warranted for more conclusive support.