title: Port extériorisation appendectomy-our experience.
abstract: BACKGROUND
  Laparoscopic appendectomy is conventionally performed using 3 ports, with division of appendicular base and artery using staples/endoloops/clips. Paucity of surgical laparoscope and laparoscopic disposables necessitated adoption of laparoscopic technique obviating the need for the above. We document our experience with the port exteriorisation appendectomy performed predominantly using two ports.
  
  
  METHODS
  Between July 2008 and April 2009, 65 appendectomies were performed at a zonal hospital, of which 26 were performed using the contemplated technique. Technical challenges, conversions, operative time, complications, postoperative recovery, and cosmesis were analysed.
  
  
  RESULTS
  Twenty-six patients (13 males and 13 females), with a mean age of 22.88 ± 11.94 years, underwent port exteriorisation appendectomy. The median operative time was 20 minutes. Two cases (7.7%) needed conversion to open appendectomy. Dense adhesions necessitated addition of a working instrument/port in two cases (7.7%). Postoperative pain was < 25 by verbal response score. Visceral component predominated on the operative day, which got confined to port sites subsequently. One patient (3.85%) developed surgical site infection. Friable, gangrenous, short fibrosed appendix on a fixed caecum and very thick abdominal wall were its limitations. Postoperative recovery and cosmesis were excellent.
  
  
  CONCLUSIONS
  Port exteriorisation appendectomy proves simple, safe, economical, and efficacious, when conditions favour its performance. However, difficult appendices warrant conversion to three ports technique or to open procedure.
authors.affiliation: Senior Resident (GE Surgery), Division of Surgical GE (General Surgery), PGIMER, Chandigarh - 160012.
authors.forename: R Saranga
authors.initials: RS
authors.lastname: Bharathi
authors.affiliation: Classified Specialist (Surgery), Military Hospital, Ramgarh.
authors.forename: Vinay
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Classified Specialist (Anaesthesia), Agra Cantt, UP - 282002.
authors.forename: Arunava
authors.initials: A
authors.lastname: Chakladar
authors.affiliation: OT Matron, Military Hospital, Agra Cantt, UP - 282002.
authors.forename: Pravin
authors.initials: P
authors.lastname: Kumari
keywords: laparoscopic appendectomy; out technique; port exteriorisation appendectomy; two ports appendectomy