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Mon Nov 3 22:48:36 GMT 2008

If I think a patient need an appendectomy, I will attempt it laparoscopically first.  However, if there is well defined right lower quadrant mass and no generalised signs - and no abscess, I would do conservative management with antibiotics, NPO etc, just like in the open era - admittedly, I have not seen a patient who fits such a picture in the last 3-4 years.  

If there is a well localised abscess in the RLQ, I will drain it percutaneously and do an interval appendectomy.  

If free perforation or any other variant - I will attempt a laparoscopic appendectomy.  

In other words -  the addition of laparoscopy to my capabilities has not changed my indications to operate or not to operate.  

I am NOT a fellowship trained laparoscopic surgeon but an acute care surgeon.

Sanjay Gupta

--- On Mon, 11/3/08, Marc Matthews - MedPro MMC X <Marc_Matthews at medprodoctors.com> wrote:

> From: Marc Matthews - MedPro MMC X <Marc_Matthews at medprodoctors.com>
> Subject: RE: PERFORATED APPENDICITIS
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>, trauma-list at trauma.org
> Date: Monday, November 3, 2008, 7:31 AM
> Dr. Moore,
>  
> Great question. I have partners that do both so I have seen
> both and the results are similar if not identical. It is not
> my perception that the results were any different short of a
> conversion to an open procedure if they could not do it with
> a scope. Pt's still went home within about the same time
> period except the open may stay a day or two longer but the
> physical outcomes were no different in terms of wound
> breakdown, formation of post-op abscess. No that is all
> anecdotal.
>  
> This is a great and timely question and I am going to pull
> and review our data.
>  
> Acute Care Surgery, sure! Some still call it General
> Surgery but our fellowship in Trauma and Acute Care Surgery
> does both.
>  
> :)
> 
> ________________________________
> 
> From: trauma-list-bounces at trauma.org on behalf of
> moore677 at aol.com
> Sent: Mon 11/3/2008 8:21 AM
> To: trauma-list at trauma.org
> Subject: Re: PERFORATED APPENDICITIS
> 
> 
> 
> I am curious if there are many out there who would just go
> for immediate appy (and accept a potentially increased risk
> of complications) or wait and do an interval appy?? Welcome
> to acute care surgery........................??
> 
> Dell................??
> 
> 
> 
> 
> 
> 
> 
> -----Original Message-----
> From: nappio at aol.com
> To: Trauma &amp; Critical Care mailing list
> <trauma-list at trauma.org>
> Sent: Mon, 3 Nov 2008 7:06 am
> Subject: Re: PERFORATED APPENDICITIS
> 
> 
> 
> What's the question?  Of course you can do it,,and if
> your good with scopes it
> shouldn't be an issue.  The question I see is whether
> they would benefit from
> perc drainage and abx first..   Back to trauma,, dn
> ------Original Message------
> From: moore677 at aol.com
> Sender: trauma-list-bounces at trauma.org
> To: trauma-list at trauma.org
> ReplyTo: Trauma & Critical Care mailing list
> Sent: Nov 3, 2008 01:06
> Subject: PERFORATED APPENDICITIS
> 
> Would any of you on the listserver attempt an appendectomy
> (lap or open) on a
> patient with a perforated appendicitis with phlegmon and
> abscess?? If so, what
> would be your indications?? I have had 2 partners within
> the last month take 2
> separate patients to the OR for the same type of
> presentation -- both able to
> succesfully remove the appendix laparoscopically.
> 
> 
> Forrest "Dell" Moore, MD
> Trauma Critical Care Surgery
> St. Joseph's Hospital and Medical Center
> Phoenix, AZ
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PERFORATED APPENDICITIS