Urgences abdominales

Urgences abdominales

L’exploration laparoscopique de la cavité péritonéale en cas d’indications chirurgicales en urgence semble être une technique de choix. [93] La laporoscopie a été proposée pour le traitement des perforations coliques, [94] des ulcères perforés, [95] dans les traumatismes pénétrants de l’abdomen, [96] dans les traumatismes de la rate. [97] Pour l’appendicectomie, l’utilisation de la laparoscopie s’est grandement développée. [98] Cependant, l’intérêt de cette technique par rapport à une incision classique semble être relativement faible, [99] sauf peut-être chez la femme en période d’activité génitale [100] et le vieillard [101] où l’aide au diagnostic est importante. Dans toutes ces indications, il faut toujours avoir en tête la très mauvaise tolérance de l’augmentation de pression intrapéritonéale en cas d’hypovolémie [102] et le risque majeur de régurgitation imposant l’utilisation systématique de l’intubation et d’une induction à séquence rapide.

Conclusion

Les techniques laparoscopiques ont révolutionné la chirurgie abdominale et imposé une adaptation de la prise en charge anesthésique. Les modifications physiologiques générées par le pneumopéritoine sont minimes pour des pressions ne dépassant pas 12 mmHg. Les contre-indications absolues sont maintenant rares, et les patients les plus fragiles semblent être ceux qui peuvent au mieux bénéficier des avantages postopératoires d’une chirurgie moins « agressive ». L’absence de douleurs et de nausées et vomissements dans la période postopératoire est essentielle pour une sortie rapide du patient et les choix anesthésiques sont primordiaux pour concourir au succès d’une prise en charge optimale.

“ Points essentiels

- Les modifications physiologiques générées par le pneumopéritoine sont minimes pour des pressions ne dépassant pas 12 mmHg.

- Les contre-indications absolues sont rares.

- L’anesthésie générale est le plus souvent proposée.

- L’intubation orotrachéale et la ventilation contrôlée sont de règle.

- Aucun argument ne justifie l’abstention de l’utilisation du protoxyde d’azote au cours de la laparoscopie.

- Une analgésie multimodale, combinant l’administration d’anesthésiques locaux avec des opiacés et des anti-inflammatoires non stéroïdiens, est la technique d’analgésie postopératoire de choix.

- L’utilisation des sétrons permet un bon traitement prophylactique des nausées et vomissements postopératoires qui sont relativement fréquents.

- Les principaux problèmes posés par la chirurgie laparoscopique de longue durée sont l’hypothermie, la diffusion du protoxyde d’azote dans le pneumopéritoine et les complications liées à la position.

- La réhabilitation postopératoire est meilleure après technique laparoscopique.

- L’insufflation du pneumopéritoine n’entraîne pas de grandes perturbations hémodynamiques et respiratoires chez le patient obèse.

Références

[1] Perissat J, Collet DR, Belliard R. Gallstones: laparoscopic treatment, intracorporeal lithotripsy followed by cholecystostomy or cholecystectomy. a personal technique. Endoscopy 1989;21:373-4.

[2] Slim K. La chirurgie colorectale par coelioscopie à l’heure de l’ « evidence-based medicine ». Gastroenterol Clin Biol 2001;25: 1096-104.

[3] Bazin JE, Schoeffler P. Anesthésie pour chirurgie par voie laparoscopique. Encycl Méd Chir 1996:6p [(Elsevier SAS, Paris), Anesthésie Réanimation, 36-569-A-10].

[4] Edelman DS. Laparoscopic cholecystectomy under continuous epidural anesthesia in patients with cystic fibrosis.AmJ Dis Child 1991; 145:723-4.

[5] Pursnani KG, Bazza Y, Calleja M, Mughal MM. Laparoscopic cholecystectomy under epidural anesthesia in patients with chronic respiratory disease. Surg Endosc 1998;12:1082-4.

[6] Gramatica Jr. L, Brasesco OE, Mercado Luna A, Martinessi V, Panebianco G, Labaque F, et al. Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease. Surg Endosc 2002;16:472-5.

[7] Hamad MA, El-Khattary OA. Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study. Surg Endosc 2003;17:1426-8.

[8] Leonard IE, Cunningham AJ. Anaesthesia for laparoscopic cholecystectomy. Best Pract Res Clin Anaesthesiol 2002;16:1-20.

[9] Pang CK,Yap J, Chen PP. The effect of an alveolar recruitment strategy on oxygenation during laparoscopic cholecystectomy. Anaesth Intensive Care 2003;31:176-80.

[10] Lu PP, Brimacombe J, Yang C, Shyr M. ProSeal versus the classic laryngeal mask airway for positive pressure ventilation during laparoscopic cholecystectomy. Br J Anaesth 2002;88:824-7.

[11] Maltby JR, Beriault MT,Watson NC, Liepert D, Fick GH. The LMAProSeal is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. Can J Anaesth 2002;49:857-62.

[12] DingY, Fredman B, White PF. Use of mivacurium during laparoscopic surgery: effect of reversal drugs on postoperative recovery. Anesth Analg 1994;78:450-4.

[13] Wahba RW, Mamazza J. Ventilatory requirements during laparoscopic cholecystectomy. Can J Anaesth 1993;40:206-10.

[14] Wittgen CM, Andrus CH, Fitzgerald SD, Baudendistel LJ, Dahms TE, Kaminski DL. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 1991;126:997-1000.

[15] Wittgen CM, Nauheim KS, Andrus CH, Kaminski DL. Preoperative pulmonary function evaluation for laparoscopic cholecystectomy. Arch Surg 1993;128:880-5.

[16] Diemunsch P, Van Dorsselaer T, Torp K, Schaeffer R, Geny B. Calibrated pneumoperitoneal venting to prevent N2O accumulation in the CO2 pneumoperitoneum during laparoscopy with inhaled anesthesia: an experimental study in pigs. Anesth Analg 2002;94: 1014-8.

[17] Taylor E, Feinstein R, White PF. Anesthesia for laparoscopic cholecystectomy: is nitrous oxide contraindicated? Anesthesiology 1992;76:541-3.

[18] Hashizume M, Sugimachi K. Study group of endoscopic surgery in Kyushu Japan: Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc 1997;11:1198-201.

[19] Noga J, Fredman B, Olsfanger D, Jedeikin R. Role of the anesthesiologist in the early diagnosis of life-threatening complications during laparoscopic surgery. Surg Laparosc Endosc 1997;7:63-5.

[20] Deroin M, Couture P, Boudreault D, Girard D, Gravel D. Detection of gas embolism by transesophageal echocardiography during laparoscopic cholecystectomy. Anesth Analg 1996;82:114-9.

[21] Councilman-Gonzales LM, Bean-Lijewski JD, McAllister RK.Aprobable CO2 embolus during laparoscopic cholecystectomy. Can J Anaesth 2003;50:313-4.

[22] Schindler E, Muller M, Kelm C. Cerebral carbon dioxide embolism during laparoscopic cholecystectomy. Anesth Analg 1995;81:643-5.

[23] Kent RB. Subcutaneous emphysema and hypercarbia following laparoscopic cholecystectomy. Arch Surg 1991;126:1154-6.

[24] Pearce DJ. Respiratory acidosis and subcutaneous emphysema during laparoscopic cholecystectomy. Can J Anaesth 1994;41:314-6.

[25] Joshi GP. Complications of laparoscopy. Anesthesiol Clin N Am 2001; 19:89-105.

[26] Dawson R, Ferguson CJ. Life-threatening tension pneumothorax during laparoscopic cholecystectomy. Surg Laparosc Endosc 1997;7: 271-2.

[27] Ludemann R, Krysztopik R, Jamieson GG,Watson DI. Pneumothorax during laparoscopy. Surg Endosc 2003;17:1985-9.

[28] Koivusalo AM, Kellokumpu I, Scheinin M, Tikkanen I, Halme L, Lindgren L. Randomized comparison of the neuroendocrine response to laparoscopic cholecystectomy using either conventional or abdominal wall lift techniques. Br J Surg 1996;83:1532-6.

[29] Koivusalo AM, Kellokumpu I, Scheinin M, Tikkanen I, Makisalo H, Lindgren L. A comparison of gasless mechanical and conventional carbon dioxide pneumoperitoneum methods for laparoscopic cholecystectomy. Anesth Analg 1998;86:153-8.

[30] Lindgren L, Koivusalo AM, Kellokumpu I. Conventional pneumoperitoneum compared with abdominal wall lift for laparoscopic cholecystectomy. Br J Anaesth 1995;75:567-72.

[31] Andersson L, Lindberg G, Bringman S, Ramel S, Anderberg B,Odeberg-Wernerman S. Pneumo peritoneum versus abdominal wall lift: effects on central haemodynamics and intrathoracic pressure during laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2003;47: 838-46.

[32] Pasqualucci A, Contardo R, Da Broi U, Colo F, Terrosu G, Donini A, et al. The effects of intraperitoneal local anesthetic on analgesic requirements and endocrine response after laparoscopic cholecystectomy: a randomized double. blind controlled study.= J Laparoendosc Surg 1994;4:405-12.

[33] Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H, et al. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multimodal analgesia: a randomized, double-blinded, placebo-controlled study. Anesth Analg 1999;89:1017-24.

[34] Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 1995;81:379-84.

[35] Moiniche S, Jorgensen H,Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 2000;90:899-912.

[36] Gupta A, Thörn SE, Axelsson K, Larsson LG, Agren G, Holmström B, et al. Postoperative pain relief using intermittent injections of 0,5% ropivacaine through a catheter after laparoscopic cholecystectomy. Anesth Analg 2002;95:450-6.

[37] Joshi GP, Viscusi ER, Gan TJ, Minkowitz H, Cippolle M, Schuller R, et al. Effective treatment of laparoscopic cholecystectomy pain with intravenous followed by oral COX-2 specific inhibitor. Anesth Analg 2004;98:336-42.

[38] Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J. Effect of CO2 gas warming on pain after laparoscopic surgery: a randomized double-blind controlled trial. Surg Endosc 1999;13: 1110-4.

[39] Tramer M, Moore A, McQuay H. Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials. Br J Anaesth  1996;76:186-93.

[40] Divatia JV, Vaidya JS, Badwe RA, Hawaldar RW. Omission of nitrous oxide during anesthesia reduces the incidence of postoperative nausea and vomiting.Ameta-analysis. Anesthesiology 1996;85:1055-62.

[41] Grundmann U, Silomon M, Bach F, Becker S, Bauer M, Larsen B, et al. Recovery profile and side effects of remifentanil-based anaesthesia with desflurane or propofol for laparoscopiccholecystectomy. Acta Anaesthesiol Scand 2001;45:320-6.

[42] Helmy SA. Prophylactic anti-emetic efficacy of ondansetron in laparoscopic cholecystectomy under total intravenous anaesthesia A randomised, double-blind comparison with droperidol, metoclopramide and placebo. Anaesthesia 1999;54:266-71.

[43] FujiiY, SaitohY, Tanaka H, Toyooka H. Ramosetron vs granisetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Can J Anaesth 1999;46:991-3.

[44] Tang J,Wang B, White PF,Watcha MF. QI J,Wender RH. The effect of timing of ondansetron administration on its efficacy, cost-effectiveness and cost-benefit as a prophylactic antiemetic in the ambulatory setting. Anesth Analg 1998;86:274-82.

[45] Frazee RC, Roberts JW, Okeson GC, Symmonds RE, Snyder SK, Hendricks JC, et al. Open versus closed cholecystectomy: a comparison of postoperative pulmonary function. Ann Surg 1991;213:651-3.

[46] Mimica Z, Biocic M, Bacic A, Banovic I, Tocilj J, Radonic V, et al. Laparoscopic and laparotomic cholecystectomy: a randomized trial comparing postoperative respiratory function. Respiration (Herrlisheim) 2000;67:153-8.

[47] Hasukic S, Mesic D, Dizdarevic E, Keser D, Hadziselimovic S, Bazardzanovic M. Pulmonary function after laparoscopic and open cholecystectomy. Surg Endosc 2002;16:163-5.

[48] Erice F, Fox GS, Salib YM, Romano E, Meakins JL, Magder SA. Diaphragmatic function before and after laparoscopic cholecystectomy. Anesthesiology 1993;79:966-75.

[49] Sharma RR, Axelsson H, Oberg A, Jansson E, Clergue F, Johansson G, et al. Diaphragmatic activity after laparoscopic cholecystectomy. Anesthesiology 1999;91:406-13.

[50] Scott TR, Zucker KA, Bailey RW. Laparoscopic cholecystectomy: a review of 12 397 patients. Surg Laparosc Endosc 1992;2:191-8.

[51] Collins R, ScrimgeourA,Yusuf S, Peto R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. N Engl J Med 1988;318:1162-73.

[52] Juul P, Christensen K. Randomized clinical trial of laparoscopic versus open inguinal hernia repair. Br J Surg 1999;86:316-9.

[53] Kozol R, Lange PM, Kosir M, Beleski K, Mason K,Tennenberg S, et al. A prospective, randomized study of open vs laparoscopic inguinal hernia repair: an assessment of postoperative pain. Arch Surg 1997;132: 292-5.

[54] Liem MS, van der Graaf Y, van Steensel CJ, Boelhouwer RU, Clevers GJ, Meijer WS, et al. Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair. N Engl J Med 1997;336:1541-7.

[55] KaldA,Anderberg B, Smedh K, Karlsson M. Transperitoneal or totally extraperitoneal approach in laparoscopic hernia repair: results of 491 consecutive herniorrhaphies. Surg Laparosc Endosc 1997;7:86-9.

[56] Lawrence K, McWhinnie D, Goodwin A, Doll H, Gordon A, Gray A, et al. Randomized controlled trial of laparoscopic inguinal versus open repair of inguinal hernia: early results. BMJ 1995;311:981-5.

[57] Lienhart A, Péquignot F, Auroy Y, Benhamou D, Clergue F, Laxenaire MC, et al. Facteurs associés à la coelioscopie dans les cholécystectomies, les appendicectomies et les cures de hernie inguinale en France. Ann Fr Anesth Reanim 2003;22:778-86.

[58] Haxby EJ, Gray MR, Rodriguez C, Nott D, Springall M, Mythen M. Assessment of cardiovascular changes during laparoscopic hernia repair using oesophageal Doppler. Br J Anaesth 1997;78:515-9.

[59] Ohta J, Kodama I,YamauchiY,Takeda J, Noutomi M, SuematsuT, et al. Abdominal wall lifting with spinal anesthesia vs pneumoperitoneum with general anesthesia for laparoscopic herniorrhaphy. Int Surg 1997; 82:146-9.

[60] Ferzli G, Sayad P, Vasisht B. The feasibility of laparoscopic extraperitoneal hernia repair under local anesthesia. Surg Endosc 1999; 13:588-90.

[61] Neumayer L, Giobbie-HurderA, Jonasson O, Fitzgibbons R, Dunlop D, Gibbs J, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004;350:1819-27.

[62] Jones DB, Soper NJ. Laparoscopic Nissen fundoplication. Surg Rounds 1994;17:573-81.

[63] Coelho JC,Wiederkehr JC, Campos AC, Andrigueto PC. Conversions and complications of laparoscopic treatment of gastrooesopageal reflux disease. J Am Coll Surg 1999;189:356-61.

[64] Schauer PR, Meyers WC, Eubanks S, Norem RF, Franklin M, Pappas TN. Mechanisms of gastric and esophageal perforations during laparoscopic Nissen fundoplication. Ann Surg 1996;223:43-52.

[65] Talamini MA, Mendoza-Sagaon M, Gitzelmann CA, Ahmad S, Moesinger R, Kutka M, et al. Increased mediastinal pressure and decreased cardiac output during laparoscopic Nissen fundoplication. Surgery 1997;122:345-53.

[66] Joris J, Chiche JD, Lamy ML. Pneumothorax during laparoscpic fundoplication diagnosis and treatment with positive end-expiratory pressure. Anesth Analg 1995;81:993-1000.

[67] Tomita H, MarcelloPW, MilsomJW. Laparoscopic surgery of the colon and rectum. World J Surg 1999;23:397-405.

[68] Fleshman JW, Fry RD, Birnbaum EH, Kodner IJ. Laparoscopicassisted and minilaparotomy approaches to colorectal diseases are similar in early outcome. Dis Colon Rectum 1996;39:15-22.

[69] Milsom JW, Bohm B, Hammerhofer KA, FazioV, Steiger E, Elson P.A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 1998;187:46-57.

[70] Milsom JW, Hammerhoffer KA, Böhm B, Marcello P, Elson P, Fazio VW. Prospective, randomized trial comparing laparoscopic versus conventional surgery for refractory ileocolic Crohn’s disease. Dis Colon Rectum 2001;44:81-93.

[71] Stage JG, Schulze S, Moller P, Overgaard H, Andersen M, Rebsdorf- Pedersen VB, et al. Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma. Br J Surg 1997;84: 391-6.

[72] SchwenkW, Böhm B, Müller JM. Postoperative pain and fatigue after laparoscopic or conventional colorectal resections: a prospective randomised trial. Surg Endosc 1998;12:1131-65.

[73] Senagore AJ, Delaney CP, Mekhail N, Dugan A, Fazio VW. Randomized clinical trial comparing epidural anaesthesia and patientcontrolled analgesia after laparoscopic segmental colectomy. Br J Surg 2003;90:1195-9.

[74] Lacy AM, Delgado S, Garcia-Valdecasas JC, Castells A, Pique JM, Grande L, et al. Port site metastases and recurrence after laparoscopic colectomy.Arandomized trial. Surg Endosc 1998;12:1039-42.

[75] Curet MJ, Putrakul K, Pitcher DE, Josloff RK, Zucker KA. Laparoscopically assisted colon resection for colon carcinoma: perioperative results and long-term outcome. Surg Endosc 2000;14: 1062-6.

[76] Ortiz H, Armendariz P, Yarnoz C. Early postoperative feeding after elective colorectal surgery is not a benefit unique to laparoscopy assisted procedures. Int J Colorect Dis 1996;11:246-9.

[77] Boccasanta P, Rosati R, Venturi M, Montorsi M, Cioffi U, De Simone M, et al. Comparison of laparoscopic rectopexy with open technique in the treatment of complete rectal prolapse: clinical and functional results. Surg Laparosc Endosc 1998;8:460-5.

[78] Poulin EC, Schlachta CM, Seshadri PA, Cadeddu MO, Gregoire R, Mamazza J. Septic complications of elective laparoscopic colorectal resection. Surg Endosc 2001;15:203-8.

[79] Köckerling F, Rose J, Schneider C, Scheidbach H, Scheuerlein H, Reymond MA, et al. Laparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Surg Endosc 1999;13:639-44.

[80] Braga M, Vignali A, Zuliani W, Radaelli G, Gruarin P, Dellabona P, et al. Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 2002;236:759-66.

[81] Chapman AE, Levitt MD, Hewett P, Woods R, Scheiner H, Maddern GJ. Laparoscopic-assisted resection of colorectal malignancies: a systematic review. Ann Surg 2001;234:590-606.

[82] Clinical outcomes of surgical therapy study group. A comparison of laparoscopically assisted and open colectomy for cancer. N Engl J Med 2004;305:2050-9.

[83] Matsuoka H, Masaki T, Mori T, Nakashima M, Sugiyama M. Laparoscopy-assisted surgery for colorectal neoplasm is justifiable regardless of advanced age. Hepatogastroenterology 2004;51:152-5.

[84] Dumont L, Mattys M, Mardirosoff C, Vervloesem N, Alle JL, Massaut J. Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients. Acta Anaesthesiol Scand 1997; 41:408-13.

[85] Dumont L, Mattys M, Mardirosoff C, Picard V, Alle JL, Massaut J. Hemodynamic changes during laparoscopic gastroplasty in morbidly obese patients. Obes Surg 1997;7:326-31.

[86] PerilliV, Sollazzi L, Bozza P, Modesti C, Chierichini A, Tacchino RM, et al. The effects of the reverse Trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery. Anesth Analg 2000;91:1520-5.

[87] Joris JL, Hinque VL, Laurent PE, Desaive CJ, Lamy ML. Pulmonary function and pain after gastroplasty performed via laparatomy or laparoscopy in morbidly obese patients. Br J Anaesth 1998;80:283-8.

[88] Juvin P, Marmuse JP, Delerme S, Lecompte P, Mantz J, Demetriou M, et al. Postoperative course after conventional or laparoscopic gastroplasty in morbidly obese patients. Eur J Anesth 1999;6:400-3.

[89] Nguyen NT, Lee SL, Goldman C, Fleming N, Arango A, McFall R, et al. Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial. J Am Coll Surg 2001;192:469-77.

[90] Nguyen NT,Wolfe BM. The physiologic effects of pneumoperitoneum in the morbidly obese. Ann Surg 2005;241:219-26.

[91] Raïga J, Barakat P, Diemunch P, Calmelet P, Brettes JP. Coeliochirurgie et obésité « massive ». J Gynecol Obstet Biol Reprod (Paris) 2000;29: 154-60.

[92] Sprung J, Whalley DG, Falcone T, Warner DO, Hubmayr RD, Hammel J. The impact of morbid obesity, pneumoperitoneum, and posture on respiratory system mechanics and oxygenation during laparoscopy. Anesth Analg 2002;94:1345-50.

[93] Catani M, De Milito R, Chiaretti M, Manili G, Spaziani E, Antoniozzi A, et al. Laparoscopy in emergency: treatment of choice in acute abdomen. G Chir 2000;21:409-16.

[94] Agresta F, Michelet I, Mainente P, Bedin N. Laparoscopic management of colonoscopic perforations. Surg Endosc 2000;14:592-3.

[95] Tsumura H, Ichikawa T, Hiyama E, Murakami Y. Laparoscopic and open approach in perforated peptic ulcer. Hepatogastroenterology 2004;51:1536-9.

[96] Miles EJ, Dunn E, Howard D, Mangram A. The role of laparoscopy in penetrating abdominal trauma. JSLS 2004;8:304-9.

[97] Nasr WI, Collins CL, Kelly JJ. Feasibility of laparoscopic splenectomy in stable blunt trauma: a case series. J Trauma 2004;57:887-9.

[98] Mancini GJ, Mancini ML, Nelson Jr. HS. Efficacy of laparoscopic appendectomy in appendicitis with peritonitis. Am Surg 2005;71:1-4.

[99] Moberg AC, Berndsen F, Palmquist I, Petersson U, Resch T, Montgomery A. Randomized clinical trial of laparoscopic versus open appendicectomy for confirmed appendicitis. Br J Surg 2005;92: 298-304.

[100] van Dalen R, Bagshaw PF, Dobbs BR, Robertson GM, Lynch AC, Frizelle FA. The utility of laparoscopy in the diagnosis of acute appendicitis in women of reproductive age. Surg Endosc 2003;17: 1311-3.

[101] Guller U, Jain N, Peterson ED, Muhlbaier LH, Eubanks S, Pietrobon R. Laparoscopic appendectomy in the elderly. Surgery 2004;135:479-88.

[102] Ho HS, Saunders CJ, Corso FA, Wolfe BM. The effects of CO2 pneumoperitoneum on hemodynamics in hemorrhaged animals. Surgery 1993;114:381-7.