Classificação laparoscópica da apendicite aguda. Correlação entre graus da doença e as variáveis perioperatórias

Abstract

BACKGROUND: Laparoscopic classification of acute appendicitis is presented. The relationship between the grades of the disease with the time of symptoms, operating time, length of hospital stay, infectious complication rate and antimicrobials use is verified. METHODS: Consecutive patients (n= 105) who underwent a laparoscopic appendectomy from January 2000, through July 2001, were studied in a prospective way. A classification of the disease in five grade was proposed: grade 0 – Normal; 1 – Hyperemia and edema; 2 – Fibrinous exsudato; 3 – Segmentary necrosis; 4A – Abscess; 4B – Regional peritonitis; 4C – Appendix base necrosis; 5 – Diffuse Peritonitis. RESULTS: The distribution of the patients according to classification was: grade 0 (10.4%); 1 (40%); 2 (29.5%); 3 (2.9%); 4A (1.9%); 4B (4.8%); 4C (3.8%) and 5 (6.7%). The mean time of symptoms high than 40 hours was related with necrosis and peritonitis possibility. The mean operating time was 31,4 minutes (range 18 – 126 minutes). The mean length of hospital stay was 39,5 hours (range 12 – 192 hours). The infectious complications were greater in grade 4 and 5. The antibiotics was used as prophylactic in grades 0, 1 and 2 and therapeutically in the others. The conversion rate was 1.9% and there was no death. CONCLUSION: The laparoscopic classification of acute appendicitis contemplated all clinical forms of the disease, made possible correlation with the time of symptoms, operating time and length of hospital stay. It allowed also, to foresee infectious complications and to rationalize the antimicrobials.