Response to Prof. Ng

Dear Sirs,

We appreciate the comments made by Prof. Ng concerning our appendectomy technique. However, we wish to note that an appendix can be withdrawn but an appendectomy cannot be performed through a cannula, because the base of the appendix has to be ligated and consequently part of the caecum must be pulled through a 10-cm cannula. Wound contamination usually occurs during resection and not during the delivery of an uncomplicated appendix; that is what probably happened in our case. Besides, care was always taken to avoid parietal contact when delivering the appendix. Furthermore, the number of our patients was small and no definitive conclusion could be drawn concerning the wound infection rates (which, according to my continuing personal experience with this technique, are much lower).

Concerning the operating times, I must insist that the patients reported on in our study were not specifically selected, and in the article it is clearly noted that in uncomplicated cases the mean operating time was 12 min, i.e., lower than with the one-puncture technique. But is this so important? In our publication we presented our experience with a simple, safe, and rapid appendectomy technique which can easily be performed in 7.5 out of 10 paediatric patients. It is a technique which does not require either the special double-port telescope or the longer instruments to work through it, and it should be noted that these instruments are not available in every department of paediatric surgery. However, we agree with Prof. Ng that conversion to more ports or even to open surgery should rather be regarded as sound judgement than as failure.

We are glad that our publication generated this dialogue and that it greatly contributed to the formulation of the interesting protocol of Prof. Ng, and we are looking forward to seeing his experience published.

I. Valioulis, M. D.