NGHIÊN cứu kết QUẢ PHẪU THUẬT nội SOI TRONG điều TRỊ VIÊM PHÚC mạc TOÀN THỂ DO VIÊM RUỘT THỪA tt tiếng anh

1 INTRODUCTION THE NECESSARY OF THESIS: Appendicitis is varied, easily mistaken with another clinical syndromes, if diagnose was late, the percentage of side-effects and death would be high Appendicitis peritonitis gets 1020% of acute appendicitis, usually is met in men (with 2/3), or in patients whom are older above 40 years old However, the cases of total appendicitis peritonitis are still cautious by surgeons and there haven’t had many studies systematically yet In order to participate in the study, we did the study because: Observe assignment, technical features of endoscopic surgery in the treatment of total appendicitis peritonitis Evaluate the results of treating total appendicitis peritonitis by endoscopic surgery at 115 People’s Hospital THE NEW MAIN SCIENTIFIC CONTRIBUTIONS OF THE THESIS: Through the study of 82 endoscopic surgical cases in treating total appendicitis peritonitis at 115 People’s Hospital from 01/01/2011 to 31/12/2016, we did: - Bring up some characteristics of clinic, paraclinic, injured surgery, bacteriology in the treatment of total appendicitis peritonitis - Identify the endoscopic surgery, which was designated to patients having total appendicitis peritonitis: in every ages, having another illness that already got treatment safely: ASA I (62%), ASA II (34,1%), ASA III (4,9%) Had old abdominal cut (6,1%), including old abdominal cut under umbilical The pressure of peritonitis 12 mmHg (100%) was effective, safe - Technical features: All of the endoscopic surgeries were put trocar, most of them were at umbilical, left pelvis and hypogastric zone The technique of treating appendix: in this study, mesentery of appendix was stopped bleeding by electrosurgical unit (monopolar), root of appendix was treated by tongs Hem-o-lok or tied Roeder threat with Vicryl 1.0 or stiched root of appendix All of cases were cleaned peritoneum and placed drainage-tube The percentage of placing Douglas drainage-tube occupied the most (85.3%), Douglas drainagetubes and HCP 10.3%, HCP tube 4.4% - The results: Endoscopic surgery in the treatment of total appendicitis peritonitis succeed by 84.2% Death 0%, stroked by anesthesia 0% The percentage of moving to opened surgery was 15.8% because the reasons included: stretchy afferent loop, dirty abdomen because of pus and pseudomembrane The results of endoscopic surgery in the treatment of total appendicitis peritonitis were Good: 90.2%; Fair: 8.6%; Average: 1.2% and Bad: 0% - Prove these positive results that showed endoscopic surgery in the treatment of total appendicitis peritonitis to be safe, high percentage of success The thesis mentioned a problem which has topicality, reality Therefore, the study the results of endoscopic surgery in the treatment of total appendicitis peritonitis is needed because this takes part in proving endoscopic surgery to be safe, effective, less side-effects, less time in hospital in treating total appendicitis peritonitis, to have scientific significance, contribute to sciences in treating total appendicitis peritonitis THE LAYOUT OF THE THESIS: The thesis has 123 pages, includes: Establish the problem: pages; Documentary overview: 34 pages; Targets and method: 24 pages; Results: 26 pages; Discussion: 35 pages; Conclusion: pages The thesis has 40 tables, graphs, 13 pictures, 118 references (specifically: 35 Vietnamese documents, 83 English documents) 2 CHAPTER : DOCUMENTARY OVERVIEW 1.1 APPENDICITIS PERITONITIS 1.1.1 Diagnose appendicitis peritonitis Defined diagnose - Clinic: + Abdominal pain at right pelvis, then spread out all abdominal cavity + Infectious signs: fever, dry lips, dirty tongue, septic shock + Symptoms: vomitting, dry skin, reduced skin elasticity… + Contractive abdominal wall + Inductive peritoneum or reactive abdominal wall + Decrease in peristalsis or lost + Rectal examination or vagina: pocket with Douglas is bloated, hurt - Paraclinic: + Bloody formula: quantity of leukocytes increases, the most is neutrophils (polymorphonuclear leukocytes, PMNs) + Abdominal X-ray doesn’t need to prepare: be able to see blurry low part, stretchy afferent loop, Laurell signal (lose light path in front of peritoneum), be able to see fecal stones + Abdominal ultra-sound: appendicitis sign, appendix gets lost continually, abdominal fluid runs freely + Abdominal CT scan: afferent loops all stretch, abdominal fluid runs freely, sign of appendicitis, appendix gets lost continually Special diagnosis : 1.2 Peritonitis because of bowel perforation Acute Pancreatitis Intestinal obstruction Primary peritonitis TREAT APPENDICITIS PERITONITIS : In this thesis, we mention about the treatment of appendicitis peritonitis The principal treatment of appendicitis peritonitis is to combine surgery with treatment of internal medicine - The purpose of surgery is to cut off inflammatory appendix and clean abdomen, drain abdominal cavity - The purpose of internal medicine is: recovery, anti-shock, return electrolyte water and anti-infection There are two procedures of surgery: 1.2.1 Opened surgery: 1.2.2 Endoscopic surgery We will talk about this part in detail below 1.3 ENDOSCOPIC SURGERY IN THE TREATMENT OF APPENDICITIS PERITONITIS 1.3.1 Designation and contraindication 1.3.1.1 Designation Main designation is to cut appendix by endoscope that are acute appendicitis’ and appendicitis peritonitis’ cases 1.3.1.2 Contraindication - Coagulation’s disorder - All contraindications for total anesthesia 3 - Peritonitis spreads out and hemodynamic instability - Many old abdomnial cuts - Severe heart and lung disease 1.3.2 Stroke and side-effects of endoscopic surgery 1.3.2.1 Stroke while being in surgery  Stroke when putting trocar - Bleeding - Bowel perforation  Stroke when injecting CO2 - Hypotension - Arrhythmia - Pneumothorax 1.3.2.2 Side-effects after endoscopic surgery of the treatment of appendicitis peritonitis - Bleeding; Infectious abdominal cavity; Infectious surgery’s cuts; Paralytic ileus; leaking cecum; stump appendicitis; Blocked small intestines; Herniated surgery’s cuts; Death 1.4 SOME NATIONAL AND INTERNATIONAL STUDIES RELATE TO ENDOSCOPIC SURGERY IN THE TREATMENT OF APPENDICITIS PERITONITIS 1.4.1 The world - In 2004, the studies from authors such as Ball and partners showed the advantages of endoscopic surgery in the treatment of appendicitis peritonitis: safe and effective, low percentage of side-effects and short time in the hospital - Next years (2009), Boris Kirshtein and parteners, like Yau and partners (2007) acknowledged that endoscopic surgery was safe and effective with short time of surgery, low percentage of side-effects, patients came back normal life quicker than opened-surgery did 1.4.2 Domestic - In 2007, Nguyen Van Phuc studied to compare effectively in treating appendicitis having side-effects (appendicitis with broken pus and abscess of appendix) between 129 endoscopic surgeries and 129 opened-surgeries concluded: for the group having endoscopic surgery, they had less infectious cuts than opened-surgery’s group did The time of staying in hospital and of treatment of injection antibiotic from endoscopic surgery were shorter than from opened-surgery More than that, endoscopic surgery brought better aesthetic satisfaction than opened-surgery did - In 2011, Ho Huu Duc reported 235 patients having appendicitis with side-effects including 35 appendicitis abscess and 200 appendicitis peritonitis which were done by endoscopic surgery with the results of 17 cases of infectious cuts, didn’t have abscess of the appendix in the abdominal cavity and all were treated preservably, no surgery again Study proved viability and safety of endoscopic surgery in all cases of broken appendix, infectious side-effects such as abscess in the abdominal cavity or infectious cuts which didn’t relate to endoscopic method - In 2011, Phan Hai Thanh studied 102 elders having appendicitis peritonitis whom had treatment by endoscopic surgery at Hue Central Hospital that had results for successful treatment by endoscopic surgery 96.1%, 3.9% of patients had to perform opened-surgery, follow up and re-check up after surgery with good result 97.3% - In 2012, Van Tan and partners reported 897 appendicitis peritonitis’ cases, which had 743 endoscopic surgeries (transfered to opened-surgeries were 93 cases, had 12.51%) with the results of having the percentage of side-effects 3.09% and had to operate again 0.26% Study also stated preeminence of endoscopic surgery to be low side-effects, less pain, small scars, shorten time in hospital CHAPTER : TARGETS AND METHODS OF STUDY 2.1 TARGETS OF THE STUDY 2.1.1 Definition of Total appendicitis peritonitis: Total appendicitis peritonitis is acute peritonitis because of broken appendicitis, or necrotizing enterocolitis In the real clinic, total appendicitis peritonitis is infectious peritoneum’s cavity with the presence of pus, pseudomembrane in peritoneum’s cavity: pus and pseudomembranes spread out the whole cavity of peritoneum, including upper and lower mesentery transverse colon 2.1.2 Standards in chosing disease - All patients were operated with endoscopic surgery in treating of total appendicitis peritonitis at External medicine, 115 People’s Hospital, from 1/1/2011 to 31/12/2016 Be diagnosed total appendicitis peritonitis based on: clinical symptoms, paraclinic, endoscopic surgery of abdominal cavity, microbiology and features of pathological anatomy - Be followed up before, in and after surgery 2.1.3 Standards in excluding Patiens had contraindication to endoscopic surgery: internal pathology didn’t allow to pump CO2 into abdominal cavity + All contraindications for total anesthesia + Peritonitis spreads out and hemodynamic instability + Severe heart and lung disease - Do not agree to operate by endoscope - Patients had peritonitis because of other reasons - Patients did not have enough medical records for this study 2.1.4 Diagnose total appendicitis peritonitis According to clinical symptoms, paraclinic before surgery and broken appendix was observed through endoscopic surgery 2.2 METHODS OF STUDY 2.2.1 DESIGN STUDY : - Study: prospection - Types of study: description, vertical observation, without control 2.2.2 COLLECTIVE DOCUMENTS : All documents needed to be collected that were defined in details such as : Charateristics of patients - Gender, Age, Permanent address Clinical characteristics - Accompanying pathology History of abdominal surgent Classify by ASA Length of appendicitis Functional symptoms appendicitis peritonitis: included stomachache and digestive disorder Infectious syndrome: patients had or not all symptoms of infectious syndrome as: fever, dry lips, dirty tongue, dehydration… Physical symptoms of peritonitis Other symptoms: included circuit frequency and body temperature of patients 5 Paraclinical characteristics - Quantity of leukocyte; Test of C Reactive Protein (CRP = C Reactive Protein); abdominal ultra-sound; abdominal X-ray stand-up without preparation; CT scan Characteristics of pathological anatomy Bacteriological characteristics Designation and technical endoscopic surgery in treating total appendicitis peritonitis Technical features of endoscopic surgery in treating total appendicitis peritonitis  Technique for putting trocar, pumping gas into abdominal cavity  Technique for cutting appendix, closing front of incision, cleaning abdominal cavity, draining abdominal cavity  Wash abdominal cavity and draining abdominal cavity  Changing to regular surgery, reasons of changing to regular surgery  The amount of time of surgery, surgical stroke, treatment and results of treating stroke The results of the treatment of total appendicitis peritonitis by endoscopic surgery - Development after surgery - Side-effects and treatment of surgical side-effects - Surgical death - Classification of results of the treatment of total appendicitis peritonitis by endoscopic surgery: We divided into levels: Good, Fair, Average, Poor - Good : Patients discharged without any side-effects - Fair : Patients had light side-effects, had common internal treatment and discharged Average : Patients had side-effects which had to perform operation and small surgery, however, there was not harmful to life - Poor : Patients had side-effects that had to surgery again 2.3 DATA ANALYSIS AND PROCESSING - All collected data were entered and processed by SPSS 22.0 software CHAPTER 3: RESULTS OF RESEARCH 3.1 Characteristics of clinic, paraclinic, injured pathological anatomy and bacteriology of targets 3.1.1 General features In 82 studied targets, the percentage of men are occupied more than the percentage of women (59.8% compared to 40.2%), the ratio was 1.5 The average age: 45.7 ± 21.4 (youngest: 16; oldest: 95) Group of age 21-40 and 41-60 occupied high percentage (32.9% and 30.5%) 3.1.2 Clinical characteristics 3.1.2.1 Length of appendicitis Table 3.6 Distribute time of appendicitis of targets Time of appendicitis (hour) Number of cases Percentage (%) ≤ 12 2.4 13 – 24 11 13.4 25 – 36 24 29.3 > 36 45 54.9 Total 82 100 The percentage of targets having appendicitis > 36 hours was 54.9% The percentage of targets having stomachache from appendicitis peritonitis got 100%, having disgestion’s disorder was 37.8% The percentage of targets having infectious syndrome was 97.6% 3.1.2.2 Physical symptoms of peritonitis Table 3.9 Physical symptoms Physical symptoms n Number of cases Percentage (%) Abdominal distention 82 75 91.5 Signet of stomachache 82 75 91.5 Inductive peritoneum (+) 82 11.0 Reactive abdominal wall (+) 82 56 68.3 Contractive abdominal wall (+) 82 17 20.7 Peristalsis sound decreased 82 41 50.0 Pocket with Douglas was swelled, hurt 76 43 56.6 Abdominal distention’s symptoms and signet of stomachache had high percentage (91.5%) 3.1.3 Paraclinical characteristics Symptom of increased leukocytes was 8.5%; decreased leukocytes was 75.6% The group of highly increased leukocytes (>15K/µL) occupied 30.5% For ultra-sound : The indication of large appendix (diameter ≥ 6mm) had percentage of 100%; the average of diameter was 10.0 ± 2.7 (6 – 18mm) The indication of lost appendix’s wall was 21.2% The abdominal fluid was 47.5%, meanwhile localized fluid had higher percentage than free fluid The amount of regular fluid was light (33.8%) 7 For vertical unprepaired abdominal X-ray: The indication of fluid retention was 39.0%; the indication of bloating ileum was 56.1% The indication of fecal stones’ appendix didn’t occupy (0.0%) For abdominal cavity’s CT scan: The sign of large appendix (diameter ≥ 8mm) was met with percentage of 100%; the average diameter 12.6 ± 3.1 (8 – 24mm) The sign of appendix’s wall continual lost was met with percentage of 68.8% The fluid in abdominal cavity was 90.6%, free fluid had higher percentage than localized fluid (81.2% compared to 9.4%) The amount of regular fluid was light (46.9%) 3.1.4 Characteristics of injured pathalogical anatomy According to the development of peritonitis had the percentage of 95.1% The condition of many bloating afferent loops was 14.6%, many pseudomembranes was 35.4% and a great amount of abdominal pus got high percentage (73.2%) The location of appendix followed by regular surgery usually had percentage 62.2% The location of necrotizing enterocolitis at the body of appendix had highest percentage (48.8%) The results in dye, mold, diagnose histopathology (n = 82): Acute necrotizing enterocolitis 100% 3.1.5 Characteristics of bacteriology The percentage of E.coli got 56.1%, bacteria didn’t grow which had 23.2%, E.coli had percentage of ESBL (-) was 67.4% Klebsiella had ESBL (+) was 61.5% 3.2 Designation and techniques 3.2.1 Technical features of endoscopic surgery of appendicitis peritonitis 3.2.1.1 Transfer to regular surgery, the reasons of transferring Table 3.23 Endoscopic surgery was transferred to regular surgery Endoscopic surgery to Regular surgery Number of cases (n = 82) Percentage (%) Endoscopic surgery to Regular surgery 13 15.8 Successful endoscopic surgery 69 84.2 82 100 Total The percentage of endoscopic surgery to regular surgery was 15.8% 3.2.1.2 Techniques in cutting appendix, closing top of surgical incision, cleaning abdominal cavity, draining abdominal cavity To cut current appendix occupied 85.5%; cut mesenteric monopolar 100%; pin root of appendix by hem-o-lock 62.3%, tie thread 27.5%; use pocket to take appendix 94.2%; take out appendix through trocar HCT 84.1% - To clean abdominal cavity and drain abdominal cavity: Table 3.30.To clean and drain abdominal cavity Number of Cases (n = 69) Percentage (%) < liter 58 84.1 – 10 liter 11 15.9 Douglas 58 85.3 HCP, Douglas 10.3 HCP 4.4 Technical features The amount of washed fluid The location of having drainage The amount of washed fluid was under liter which occupied 84.1%, from to 10 liter was 15.9% The location of having Douglas drainage occupied the most (85.3%), Douglas and HCP drainage was 10.3%, HCP was 4.4% 3.2.1.3 The length of surgery, surgical stroke, solution and the results of treating stroke - The length of surgery: average 101.2  34.7 minutes (45 – 180 minutes) - Surgical stroke: There was case that appendix was fell in abdominal cavity (1.2%) To handle this stroke, there was a regular surgery to take appendix out successfully 3.3 The results of treating appendicitis peritonitis by endoscopic surgery 3.3.1 Development after surgery 3.3.1.1 The time took out drainage’s tube, time of flatus, length of staying in hospital after surgery The time took drain out after 72 hours that occupied the most (72.5%); took out before 25 hours was 1.4%, took out around 25 – 48 hours was 4.3% The time of flatus after surgery was 49 – 72 hours which was 23.2%, over 72 hours was 52.2%; before 25 hours was 2.9% The average length of staying in hospital after surgery was 5.9  3.5 days; shortest length was day, longest one was 30 days 3.3.2 Side-effects and how to treat surgical side-effects 3.3.2.1 Surgical side-effects Table 3.3.3 Surgical side-effects Number of cases (n = 82) Percentage (%) Paralytic ileus 6.2 Infectious surgical incision 2.4 Surgical side-effects Seroma after surgery Total 1.2 9.8 Side-effects after surgery was 9.8% To treat surgical side-effects: Internal treatment 7/8 cases (87.5%), case which had to be sucked seroma out combining internal treatment (12.5%) The results of treating side-effects 100% 3.3.3 Surgical death Surgical death: 0.0% 3.3.4 peritonitis Classify the results of the treatment of endoscopic surgery of appendicitis To classify the results in treating endoscopic surgery of appendicitis peritonitis based on the standards of Hospital: Good result was 90.2%, Fair 8.6%, Average 1.2%, Poor 0.0% CHAPTER : DISCUSSION 4.1 Characteristics of clinic, paraclinic, injured pathology antomy and bacteriology of researched targets 4.1.1 Common characteristics age and gender We studied about 82 patients, having average age was 45.7  21.4 years old The percentage of female patients was 40.2% (33/82), the percentage of male patients was 59.8% (49/82) and the ratio between male over female was 1.5 The comment needed to be paid attention and studied deeply, more patients than this study respectively 4.1.2 Clinical characteristics 4.1.2.1 The time of appendicitis In our study, distribution of appendicitis > 36 hours occupied the highest percentage of 54.9%, next group was 25 – 36 hours taking 29.3%, the last groups  12 hours and 13 – 24 hours occupied the lowest percentage of 2.4% and 13.4% respectively According to Nguyen Van Hai (2010) noted the time from having signal of stomachache to having surgery: the number of patients was operated before 12 hours only had 6.67% Most of them were operated after 24 hours (51/90 patients, with 56.66%), the number of patients was diagnosed and operated after 48 hours occupying 13.33% 4.2.1.2 Physical symptoms of peritonitis Our study noted clinical symptoms which usually had seen: abdominal distention, signet of stomachache, positive reactive abdominal wall with high percentage These symptoms corresponded to the ratio of peritonitis Clinical symptoms helped in diagnosis which was inductive peritoneum in 11% patients and reactive abdominal wall was met in 68.3% of all cases Yilmaz (2007) noted that there were 69% patients whome had pain in the right pelvis and 21% pain spreading out around abdomen Jhobta (2006) noted clinical symptoms in patients having appendicitis had side-effects: 77% had inductive peritoneum and 68% had reactive abdominal wall in the right pelvis, rectal examination had tightly painful which only was appeared in 54% cases 4.2.2 Paraclinical characteristics 4.2.2.1 The amount of leukocytes 10 In this study, we observed the amount of leukocytes increased which had percentage of 75.6%, among of them, increased leukocytes >15K/L took 30.5% 4.2.2.2 Ultra-sound In this study, ultra-sound was images’ diagnosis that we were used the most (80/82 patients) to help in diagnosis Ultra-sound detected large appendix  6mm with 100% and sign of continual lost appendix’s wall was 21.2% Crombe (2000) noted sensitivity of ultrasound to be 91.5% and specificity was 94.3%, the percentage of accurate diagnosis of ultrasound was: 93% 4.3 Designation and techniques 4.3.2 Characteristics of basic factor’s designation We designated endoscopic surgery for all patients having appendicitis peritonitis excepting cases of contraindications which were said above 4.3.3 Technical features of endoscopic surgery in total appendicitis peritonitis - Moved to regular surgery, reasons to move to regular surgery The condition of abdominal cavity related to creating empty space of procedures: many bowel loop distentions 14.6% The condition of abdominal cavity related to the procedures of cleaning abdominal cavity: many pseudomembranes 35.4% In our study, there were 69 successful cases of endoscopic surgery, with 84.2% (69/82) and 13 endoscopic surgical cases were changed to regular surgery, with 15.8% (13/82) We had 13 cases that we had to change to regular surgery, took 15.8% The percentage of regular surgery of Katkhouda (2005) was 8% because of these reasons: sticky abdominal wall could not be pumped peritoneum, because the surgical structure was not normal or had trouble in dissection Notes of Liu (2002) cases of appendicitis had breakage percentage of regular surgeries with 26.4%, among of them were 36.2% cases which were due to stick to each other could not define the mark of operation, 12.1% was due to peritonitis localized, 10.3% was due to total peritonitis, and 8.6% was due to necrotizing enterocolitis of root of appendix spreading out to cecum, 8.6% of regular surgeries was due to appendix to be behind cecum that could not dissection, 6.9% was due to uncontrollable bleeding mesentery, or too much bleeding because of injured abdominal blood vessels, or bleeding necrotizing enterocolitis from inflammable organs around appendix Another reason was not be able to find appendix that regular surgery had to be performed to look for appendix (this percentage was 5.2%) Other reasons was mentioned because of electronic knife, during peeling and separating, this caused burns, perforation in small intestine so that regular surgery had to be applied 4.3.4 Techniques in cutting appendix, closing top of surgical incision, cleaning abdominal cavity, draining abdominal cavity 4.3.4.1 To cut mesentery of appendix In our study, mesentery of appendix was treated following: to cut node stopping bleeding of mesentery with node of monopolar 100% 4.3.4.2 To treat root of appendix In this studey, we all used clip Hem-o-lock to pin root of appendix (62.3%) or technique in tie root of appendix by vicryl threads outside then putting in peritoneum’s cavity (27.5%), tied root of appendix by this threads with others Having good result, there was any cases that threads came out root of appendix after surgery Compared to results of other researchers, we realized this was still safe and effective, low cost, suitable for our country’s conditions 11 4.3.4.3 To clean and drain abdominal cavity This technique was identified that to be very important in endoscopic surgery of cutting appendix in the treatment total appendicitis peritonitis If this was done well, there would avoid many risks leading to side-effects after surgery Therefore, we proceeded to clean peritoneum’s cavity with saline solution with unlimited amount The amount we used approximately 5L per surgical case We rinsed each cavity of peritoneum sequentially: started with sucking pus out, took of sticky pseudomembranes We washed peritoneum’s cavity and put drainage in all cases Meanwhile, the percentage of putting Douglas drain’s tube occupied the most (85.3%), tubes Douglas and HCP 10.3%, tube HCP 4.4% 4.3.4.4 The time of operation Our average time, which performed endoscopic surgery, was: 100.0  37.1 minutes, shortest time was 45 minutes and longest one was 200 minutes The average surgical time of regular surgeries was: 107.4  24.9 minutes, shortest one was 80 minutes and longest one was 160 minutes Katsuno (2008) noted the average time of surgery was: 116  45 minutes 4.3.4.5 Surgical stroke, treatment and results of treatment of stroke  Surgical stroke We only had case that appendix was fell out in abdominal cavity (1.2%) To handle this case was to perform regular surgery to take out appendix successfully 4.4 The results of treating total appendicitis peritonitis by endoscopic surgery 4.4.2 Time of taking out drainage’s tube, time of flactus, length of staying in hospital after surgery  Average time of saving drainage’s tube was: 3.9  1.7 days at every endoscopic surgical cases and at regular surgical cases was: 3.7  1.1 days  Average time that patients had returned flactus was 1.6  0.9 days  The shortest length of staying in hospital was days, longest length was 31 days and average was 6.6  3.6 days Katsuno (2008) noted length of staying in hospital was 8.9  3.7 days Tran Huu Vinh (2014) : the average length of staying in hospital of every patients was 6.5  1.3 days, the time of flactus was 45.3  20.4 hours  The time of treatment: Good was 90.2%, Fair was 8.6%, Average was 1.2%, Poor was 0.0% 4.4.3 Side-effects and treatment of surgical side-effects We had case which had seroma after surgery causing abscess after surgery occupied 1.2% There was case having infectious umbilical trocar regarding to endoscopic surgery (1.2%) and case getting infectious incision regarding to endoscopic surgery transferred to regular surgery (1.2%) This study had patients whom had paralytic ileus early on day th after surgery, showing condition of intestinal obstruction: vomitting, stopping defecation, stomachache, abdominal distention Internal medicine treatment: put through stomach to be pumped out constantly, antibiotic, transfer fluid additional electrolyte water, after that patients were stable and discharged on day 10th Study of Fukami (2007) had the percentage of abscess of peritoneum’s cavity after surgery was 5.9% Katsuno (2008) the percentage of abscess of peritoneum’s cavity after surgery was 4.8% towards regular surgeries and 1.8% in endoscopic surgeries The percentage of infectious incisions was 23% in regular surgeries compared to 12.5% in endoscopic surgeries CONCLUSION 12 Through the study of 82 endoscopic surgical cases in treating total appendicitis peritonitis at 115 People’s Hospital from 01/01/2011 to 31/12/2016, we had conclusions below: Designation and technical features in the treatment of total appendicitis peritonitis by endoscopic surgery - Endoscopic surgery was desginated to patients whom had total appendicitis peritonitis: + In every age + To have another illness that already got treatment safely: ASA I (62%), ASA II (34,1%), ASA III (4,9%) + To have old abdominal cut (6,1%), including old abdominal cut under umbilical + The pressure of peritonitis 12 mmHg (100%) was effective, safe - Technical features: + All of the endoscopic surgeries were put trocar, most of them were at umbilical, left pelvis and hypogastric zone + The technique of treating appendix: in this study, mesentery of appendix was stopped bleeding by electrosurgical unit (monopolar), root of appendix was treated by tongs Hem-o-lok or tied Roeder threat with Vicryl 1.0 or stiched root of appendix + All of cases were cleaned peritoneum and placed drainage-tube The percentage of placing Douglas drainage-tube occupied the most (85.3%), Douglas drainagetubes and HCP 10.3%, HCP tube 4.4% Evaluation of the results in the treatment of total appendicitis peritonitis by endoscopic surgery - Endoscopic surgery in the treatment of total appendicitis peritonitis succeed by 84.2% Death 0%, stroked by anesthesia 0% The percentage of moving to opened surgery was 15.8% because the reasons included: stretchy afferent loop, dirty abdomen because of pus and pseudomembrane - The percentage of endoscopic surgery had to transfer to regular surgery which related factors: abdominal distention, stretchy bowel loop, many thick pseudomembranes, creation stickiness in abdominal cavity Thus, the cases that patients arrived late, abdominal distention a lot and dirty abdominal cavity, many thick pseudomembranes so that they should ask for regular surgery - The average time of endoscopic surgery was 101.2  34.7 minutes per case - The results of 82 patients having endoscopic surgery: + The time that patients had flactus back more than 72 hours was 52.2% + The average length of staying in hospital was 5.9  3.5 days + The percentage of side-effects after surgery was 9.8%, including cases of paralytic ileus, cases of infectious incisions and case of seroma after surgery There was no severe side-effects and none of cases which had to operate again + No side-effects related to anesthesia after surgery (0%) + No death (0%) + The results of endoscopic surgery in the treatment of total appendicitis peritonitis were Good: 90.2%; Fair: 8.6%; Average: 1.2% and Poor: 0% - We acknowledged that endoscopic surgery in the treatment of total appendicitis peritonitis was safe, high percentage of success 13 ... abdominal cavity and drain abdominal cavity: Table 3.30.To clean and drain abdominal cavity Number of Cases (n = 69) Percentage (%) < liter 58 84.1 – 10 liter 11 15.9 Douglas 58 85.3 HCP, Douglas... many thick pseudomembranes, creation stickiness in abdominal cavity Thus, the cases that patients arrived late, abdominal distention a lot and dirty abdominal cavity, many thick pseudomembranes... cutting appendix, closing front of incision, cleaning abdominal cavity, draining abdominal cavity  Wash abdominal cavity and draining abdominal cavity  Changing to regular surgery, reasons of