prospective studies have shown the superiority of laparoscopic appendectomy in the treatment of acute appendicitis . however , this technique has not yet gained widespread acceptance because of its longer operative time and lower cost effectiveness when compared with the open approach . moreover , although recent retrospective studies have shown that laparoscopic appendectomy is associated with a significantly shorter hospital stay , other reports demonstrate no significant difference in hospital stay when the laparoscopic and the open approach were compared .
the minilaparoscopic approach is associated with less abdominal wall trauma , a lower infection rate at the trocar site and abdominal wall hernia , and produces excellent cosmetic results . in this study ,
our goal was to confirm the safety and show the feasibility of the minilaparoscopic approach for the treatment of acute appendicitis .
between may 1999 and june 2001 , a minilaparoscopic appendectomy was attempted in 37 patients with a preoperative diagnosis of acute appendicitis and without a previous history of abdominal surgeries .
the pneumoperitoneum was created by insertion of a veress needle through a small incision in the umbilicus .
a 2.2-mm trocar was placed laterally to the left rectus abdominis muscle and served to manipulate a 2.2-mm , 0-degree laparoscope .
another 5-mm trocar was placed just below the umbilical crease and was used for the ultrasonic scalpel .
a third 2.2-mm trocar was placed suprapubically in the midline and was used for grasper access .
exploration of the right lower abdominal cavity identified either an inflamed appendix or ruled out appendicial pathology . in the presence of appendicial pathology ,
the appendix was held with an atraumatic grasper and dissected with a 5-mm ultrasonic scalpel .
an endoloop was positioned at the base of the appendix and tied 1 cm distally to its base .
the appendix was then dissected by using an ultrasonic scalpel and placed in a sterile 8 and 1/2-size glove finger used as a specimen bag and removed through the 5-mm trocar site .
all specimens were sent to the pathology laboratory for analysis . at the end of the procedure ,
all trocars were removed and the fascial defect at the 5-mm trocar site was repaired with absorbable sutures .
all skin wounds were closed with steri - strips , and sterile dressings were applied .
all patients were discharged with written instructions regarding diet , physical activity , use of oral nonsteroidal anti - inflammatory drugs ( nsaids ) for pain control , and follow - up clinic visits were scheduled for 1 week , 1 month , and 6 months postoperatively .
the study population consisted of 37 patients , of which 7 were males and 30 were females .
the average age of the patients was 26 years ( range , 7 to 48 ) .
minilaparoscopic appendectomy was initially attempted in 37 patients ; however , it was only completed in 31 ( 84% ) . in 2 patients ( 5.3% ) , the procedure was completed with the conventional laparoscopic approach , because both patients had a perforated appendix .
both patients were operated on with larger trocars and instruments because this made it safer to manipulate and resect the appendix and to wash the abdominal cavity . in 1 patient ( 2.7% ) , the procedure was converted to an open approach through a midline incision due to diffuse fecal peritonitis as a consequence of a ruptured appendix . in 3 patients ( 8% ) , an appendectomy was not performed because of pathology confined to the ovary .
one wound infection occurred at the umbilical trocar site , which was treated conservatively . during the extraction of the specimen through the 2.2-mm umbilical trocar , the specimen bag ruptured and the inflamed appendix contaminated the abdominal wall .
of the 31 patients , four patients ( 13% ) had a normal appendix , 26 patients ( 84% ) had acute appendicitis , and 1 patient ( 3% ) had a perforated appendix .
the average operating time was 34 minutes ( range , 15 to 80 ) , and the median length of stay was 1.2 days ( range , 1 to 5 ) .
postoperative pain management consisted of 2 doses of 10 mg of ketorolac tromethamine given intravenously . in all patients , wounds resulting from trocar placement healed well .
previous studies have confirmed the superiority of laparoscopic appendectomy in the treatment of acute appendicitis .
it is associated with decreased postoperative pain , a shorter length of hospitalization , a faster return to normal activity , an early resumption of dietary intake , and fast resolution of postoperative ileus . however , this technique has not yet gained widespread acceptance because of its longer operative time and higher cost compared with the open approach . in a prospective , randomized study of 50 patients , minn et
al showed that the laparoscopic approach did not offer any improved benefits compared with the open approach for the routine patient with acute appendicitis .
nevertheless , we believe that the laparoscopic approach allows good exploration of the abdominal cavity and may be helpful in ruling out different pathological states . in our experience ,
minilaparoscopic exploration of the abdominal cavity diagnosed pathology of the ovary in 8% of patients .
it has been shown that 80% of women who underwent an open appendectomy , compared with 10% of women treated with laparoscopic appendectomy , may develop adhesions that in fact may be responsible for the infertility or chronic abdominal pain , or both . based on our experience , the procedure was completed with the conventional laparoscopic approach in 2 patients ( 5.3% ) because of a perforated appendix .
we have learned that it was safer to insert bigger trocars and instruments to manipulate and resect the appendix , and also wash the abdominal cavity .
we believe that converting to conventional laparoscopy was not a technical regression because the outcome did not differ from the outcome in those who underwent the minilaparoscopic appendectomy .
it is generally true that the cost of laparoscopic appendectomy is higher than that of open appendectomy .
although shorter hospitalization , less pain medications , and better patient compliance are well - established benefits associated with laparoscopic treatment , the financial burden associated with it in the long - term is also well established .
sterile use of finger cut gloves instead of sterile specimen containers and use of nondisposable trocars and instruments may contribute greatly to the reduction in cost .
it can be used multiple times ; it is versatile and can be used for other minimally invasive procedures , thus lowering its overall cost .
the benefits of the laparoscopic approach in terms of better diagnostic accuracy and safety , especially for women of childbearing age , outweighs the disadvantage of a longer average operative time of about 17 minutes . in terms of advantages associated with the use of the minilaparoscopic approach , a reduction in abdominal wall trauma and a decrease in the number of complications , such as infection of the trocar site and abdominal wall hernia have been reported elsewhere . moreover , the smaller dimension of the trocars accounts for approximately a 70% reduction in postoperative pain , compared with that for the conventional laparoscopic approach .
one patient , however , developed a wound infection at the umbilical trocar site that resulted from direct contact of the inflamed appendix with the abdominal wall after rupture of the finger bag .
to avoid such a complication in the future , we modified the technique by extracting the bag though the 5-mm suprapubic incision , and since then no similar complications have occurred .
the wounds from trocar placement healed well , and the general condition of all patients was excellent at 6-month follow - up .
this study shows that the minilaparoscopic approach has the same advantages as the conventional approach in terms of better diagnostic accuracy and safety , especially for women of childbearing age .
 background : minilaparoscopic appendectomy for appendicitis is not a well - established procedure . 
 this approach provides less abdominal wall trauma , fewer complications , and excellent cosmetic results . 
 our aim was to show the feasibility and safety of the minilaparoscopic approach.methods:minilaparoscopic appendectomy was performed in 37 patients . 
 two 2.2-mm trocars were used to manipulate a 2.2-mm , 0-degree laparoscope and for grasper access . 
 a 5-mm trocar was used for the ultrasonic scalpel.results:no deaths occurred . in 3 patients ( 8% ) 
 , appendectomy was aborted due to pathology of the ovary . 
 conversion to the open approach occurred in 2.7% of patients . 
 the average operating time was 34 minutes ( range , 15 to 80 ) , and the median length of hospital stay was 1.2 day ( range , 1 to 5).conclusions : the minilaparoscopic approach a ) has the same advantages as the conventional laparoscopic approach in terms of better diagnostic accuracy and safety ; b ) a low incidence of complications ; and c ) yields excellent cosmetic results . 
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION