Rationale for prompt access to the appendix in people with abdominal obesity.

Abstract

Relevance. Currently, acute appendicitis occupies a leading position in the structure of surgical diseases that require urgent surgical intervention. A significant part of operations for acute inflammation of the appendix is ​​performed from the laparoscopic approach. But, despite the wide possibilities of modern medicine, it is often necessary to resort to traditional laparotomic access. The classic access to the appendix is ​​the access via Volkovich-Dyakonov through the Mac-Burney point or the Lanz point. In fact, in most cases, the projection of the base of the appendix does not coincide with the Lanz and Mac-Burney points. This is due to differences in the location of the appendix in the abdominal cavity, as well as with individual constitutional parameters, including the presence or absence of obesity. In addition, in women the dome of the cecum and the appendix are slightly lower than in men. Considering these aspects, as well as the inadmissibility of delaying surgical treatment, it becomes necessary to determine the access point to the appendix as clearly and quickly as possible.
 Aim is development and implementation of the surgeon’s intellectual decision support system (IDSS) in the definition of operative access to the appendix in people with abdominal obesity.
 Materials and methods: for the development of the IDSS of the surgeon, 101 SKT images were analyzed, which were used to build 3D models of the studied areas. 3D modeling allows for more accurate geometric measurements. The program “Inobitec DICOM Viewer” was used to work with images. It was decided to use the development environment “Embarcadero Delphi XE7” to implement the decision support system.
 Results: an algorithm was developed to support the surgeon's decision in determining prompt access to the appendix, and the software implementation of the IDSS of the surgeon was completed. The IDSS of the surgeon was tested and showed good results.
 Conclusion: the development of the IDSS of the surgeon is designed to speed up preoperative preparation and significantly reduce the number of medical errors in determining prompt access to the appendix, which is important in urgent surgery.