TACTICAL APPROACHES TO THE SURGICAL TREATMENT OF PATIENTS WITH COMPLICATED FORMS OF ACUTE APPENDICITIS WITH A HIGH RISK OF CARDIOPULMONARY INSUFFICIENCY

Acute appendicitis is the most common abdominal surgery, and appendicectomy is still the most commonly used surgical procedure. Performed for over a century by a mini-incision in the right iliac fossa, in most cases, the appendectomy could be included in the group of minimally invasive operations. In the last two decades, major changes in the diagnosis and treatment of surgical disorders have also had an impact on the appendix pathology. A first progress was made in the diagnosis of acute appendicitis through the widespread use of imaging, especially ultrasound, which led to a more accurate diagnosis and reduction of unnecessary appendectomies. The second major therapeutic change was performing and spreading laparoscopic appendectomy, with all the well-known advantages of minimally invasive interventions. The European Association of Endoscopic Surgery (EAES) recommends diagnostic laparoscopy in patients with suspected acute appendicitis. In the US and developed countries, most acute appendicitis is treated laparoscopically, although laparoscopic appendectomy cannot be considered as a "golden standard" yet. We present below the experience in laparoscopic appendectomy that we use in the clinic.