Nuevos paradigmas en el manejo de la apendicitis

Objetivo: Analizar y comparar los resultados obtenidos con las diferentes tecnicas quirurgicas que existen y el manejo conservador de la apendicitis. Sede: Instituto de Investigaciones Medico-Biologicas y Facultad de Medicina de la Universidad Veracruzana. Diseno: Revision de la literatura. Material y metodos: Se procedio a la revision bibliografica de los principales articulos cientificos publicados en los ultimos 6 anos, asi como las bases de datos en las fuentes electronicas de las bibliotecas EBSCOhost, Cochrane y UpToDate. Se analiza y presenta toda la literatura critica sobre el tratamiento de la apendicitis complicada y no complicada por medio de cirugia convencional, cirugia laparoscopica, NOTES®, cirugia a traves de un solo puerto, manejo medico y/o manejo conservador, publicadas entre los anos 1996 y 2012. Resultados: La apendicetomia convencional ha sido durante muchos anos el estandar de oro para su manejo. En 1982, se introdujo el abordaje laparoscopico que ha demostrado ser tan seguro y eficiente como la cirugia convencional; posteriormente, en 2004, se introdujo la cirugia endoscopica a traves de orificios naturales (NOTES®), y en 2007, la cirugia a traves de un solo puerto. Recientemente, han aparecido publicaciones sobre su manejo conservador con cirugia de intervalo, lo cual evita un gran numero de intervenciones innecesarias con morbimortalidad, comparables a los pacientes sometidos a cirugia en forma urgente. Conclusiones: La apendicetomia continua siendo el estandar de oro del manejo de la apendicitis aguda; sin embargo, han surgido alternativas de manejo diferentes al criterio quirurgico tradicional, las cuales han demostrado ser utiles y permiten disminuir la cirugia innecesaria, sin incremento de la morbimortalidad.(AU) Objective: To analyze and compare the results obtained with the diverse surgical techniques currently in use and the conservative management of appendicitis. Setting: Institute of Medical Biological Research and School of Medicine of the University of Veracruz, Mexico. Design: Review of the literature. Material and methods: We performed a bibliographical review of the main scientific articles published in the last 6 years, as well as of the databases contained in the EBSCOhost, Cochrane and UpToDate electronic libraries. We analyze and present critical literature on the management of complicated and non-complicated appendicitis by means of conventional surgery, laparoscopic surgery, NOTES® surgery, one-port surgery, medical handling and/or conservative management, published between 1996 and 2012. Results: Conventional appendicectomy has been for many years the gold standard for its management. In 1982, the laparoscopic approach was introduced and has shown to be as safe and efficient as conventional surgery; later on, in 2004, the natural orifice transluminal endoscopic surgery (NOTES®) was introduced, and surgery through only one port was introduced in 2007. Recently, reports on the conservative management with interval surgery have been published, which avoids a large number of unnecessary intervention with morbidity and mortality comparable to that of patients subjected to emergency surgery. Conclusions: Appendicectomy remains the gold standard for the management of acute appendicitis; however, alternatives have arisen for a different management to that of the traditional surgical criterion, which have demonstrated to be useful and have allowed diminishing unnecessary surgeries, without increasing morbidity and mortality.(AU)