Mesoappendix position variations in laparoscopic appendicectomy; a new anatomical classification to guide surgical...

Area of Science:

• Laparoscopic surgery
• Surgical anatomy
• Gastrointestinal surgery

Background:

• Mesoappendix dissection is key in laparoscopic appendicectomy.
• Mesoappendix positional variations are not well-described.

Purpose of the Study:

• To classify mesoappendix positions during laparoscopic appendicectomy.
• To evaluate the impact of these positions on surgical difficulty and approach.

Main Methods:

• A four-category classification (M1-M4) for mesoappendix position was proposed.
• 104 laparoscopic appendicectomy cases were reviewed and categorized.
• Operative time, port use, energy device use, and approach deviations were assessed.

Main Results:

• Mesoappendix positions were classified as M1 (30), M2 (31), M3 (27), and M4 (16).
• The M3 position was associated with significantly longer operative times (p<0.001).
• M3 cases more frequently required additional ports and non-standard dissection techniques.

Conclusions:

• A novel classification system for mesoappendix position in laparoscopic appendicectomy is introduced.
• The M3 position presents significant challenges, increasing operative difficulty and complexity.
• This classification can aid intra-operative decision-making in laparoscopic appendicectomy.