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LETTER TO THE EDITOR |
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| Year : 2013 | Volume
: 9
| Issue : 1 | Page : 45 |
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The "BASE FIRST" technique in laparoscopic appendectomy
Ketan Vagholkar
Department of Surgery, Padmashree Dr. D. Y. Patil Medical College, Nerul, Navi Mumbai, Maharashtra, India
| Date of Web Publication | 14-Feb-2013 |
Correspondence Address:
Ketan Vagholkar
Professor of Surgery, Annapurna Niwas, 229 Ghantali Road, Thane - 400602, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-9941.107143
How to cite this article:
Vagholkar K. The "BASE FIRST" technique in laparoscopic appendectomy. J Min Access Surg 2013;9:45 |
Dear Sir,
I read with interest the article entitled "The 'BASE FIRST'" technique in laparoscopic appendectomy. [1] The authors' suggestion of using the "Base First" technique for all laparoscopic appendectomy cases is confusing. The statements which the authors have made to advocate the method are misleading, self-contradictory, and need clarification.
The authors' claim of having successfully operated upon all cases including 15 complicated cases with adhesions or with abscesses and 12 suppurated ones is misleading. It is very difficult to accept that in a case wherein the appendix is retrocecal in position with extensive superadded adhesions or with abscess formation, it was possible to define the base clearly before creating a window between the mesoappendix and the appendix. Usually it is always seen that in complicated cases it is not only extremely difficult to identify and define the base but is also dangerous, as there is a high likelihood of damaging the cecum with a resultant fecal fistula. Therefore there is always a tendency to remain safely away from the friable base while tightening an endoloop or while firing a stapling device, thereby leaving behind a long stump. This long stump can be a cause for recurrent appendicitis. [2] In such cases it is always safe either to identify the tip or the middle portion of the appendix to reach its base. Therefore the technique described by the authors would be acceptable only in a case of an uncomplicated inflamed appendix.
The cost issue also needs to be considered while adopting this technique especially in the developing world, wherein financial constraints many a times decide the approach to the patient. This technique only adds to the cost without significant surgical advantage as compared to open surgery. [3]
The authors in the concluding paragraph have used certain unacceptable adjectives such as "inexperienced" and "nonskilled." I would like to clarify that the branch of surgery is all about developing technical skills. The standard time tested approach to laparoscopic training as accepted world-wide follows the sequence of open surgery -- learning on an endo-trainer -- assisting laparoscopic surgeries. Only after having gone through this process is the surgeon capable of managing laparoscopic cases independently. [4] A surgeon devoid of proper experience should refrain from utilizing the laparoscopic technique. At the same time, a surgeon devoid of skills as described by the authors as "nonskilled" should cease to function as a surgeon.
Hence I feel it is very important to justify and stress upon technical advantages, cost effectiveness, and rigorous development of surgical skills before advocating any new technique, in the best interest of surgical safety of the patient population.
| ¤ References | |  |
| 1. | Piccini G, Sciusco A, Gurrado A, Lissidini G, Testini M. The "BASE FIRST" technique in laparoscopic appendectomy. J Minim Access Surg 2012;8:6-8. 
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| 2. | Devereaux DA, Joseph P, McDermott MD, Phillip F, Canshaj MD. Recurrent appendicitis following laparoscopic appendicectomy. Dis Colon Rectum 1994;37:719-20.
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| 3. | Ignacia RC, Burke D, Spencer C, Bissell C, Dursainvil C, Lucha PA. Laparoscopic versus open appendectomy: What is the real difference? Results of a prospective randomized double blinded trial. Surg Endosc 2004;18:334-7.
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| 4. | Lekawa M, Shapiro SJ, Gordon LA, Rothbart J, Hiatt JR. The laparoscopic learning curve. Surg Laparosc Endosc 1995;5:455-8.
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