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Laparoscopic Appendectomy

What is Appendix?

The appendix is a small, finger-shaped protrusion from Caecum which is the first part of colon. It is normally found in the lower right quadrant of the abdomen. It is a tubular blind ended organ.


What is Appendicitis?

If the end of the appendix that is connected to the intestine is blocked then appendix gets swollen and this is called appendicitis. So appendicitis is inflammation of the appendix. It may be acute or chronic.


Why is it difficult to diagnose Appendicitis?

Diagnosing appendicitis can be challenging. Half of all patients who have appendicitis do not have typical symptoms – the pain may be located in different parts of the body. Other conditions may have very similar symptoms of pain in right lower abdomen may be associated with swelling ofOvary, Uterus, Kidney Stone, Pancreas, Duodenal ulcer, Colitis, Urinary tract infection or Gastroenteritis.

Not everybody has their appendix in exactly the same place – some are located behind the colon, behind the liver, or in the pelvis or left side of the abdomen.


How is Appendicitis diagnosed?

A physician looks for tenderness in the lower right quadrant of your abdomen. In addition he may also perform several tests for appendicitis.

Pelvic exams can make certain that women don’t have reproductive problems.

Urinalysis can rule out a urinary tract infection or kidney stone.

White blood cell count study helps to diagnose infection

Pregnancy tests can rule out a suspected ectopic pregnancy.

Abdominal imaging can determine if you have an abscess or other complications. This may be done with an X-ray, ultrasound or CT scan. However CT Scan involves exposure to lot of radiation.

 

Treatment of Appendicitis.

Appendicitis can be treated conservatively by antibiotics and IV Fluids. However the possibility of recurrence of symptoms or complications remains, hence urgent appendectomy is advocated.

Appendectomy can be performed by open technique or by laparoscopy.

a) Open Appendectomy

It requires an incision which is about two to five inches long. This may result in cosmetically unsightly scar. The intestine may become adherent to the wound or to each other due to handling. The possibility of wound infection and herniation also remains. Lastly the surgeon cannot view the rest of the abdomen. The recovery post surgery takes longer, where by increasing cost of hospitalization and antibiotics.

b) Laparoscopic Appendectomy

Laparoscopy is less invasive, recovery time is shorter.

Patient is kept empty stomach for atleast 8 hours prior to surgery. The patient is put under general anesthesia and a telescope in inserted into abdominal cavity. Additional instruments are used to remove the blood supply of appendix. Finally the appendix is tied at the base and removed.The surgeon can then view rest of the abdomen and treat any other coexisting pathology.

 


What are the advantages of Laparoscopy?

There are a number of advantages to the patient with laparoscopic surgery versus an open procedure.

These include:

Reduced hemorrhage, which reduces the chance of needing a blood transfusion.
Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.

Contact of infection with the wound is prevented hence possibility of wound infection is drastically reduced. Any other diagnostic cause of right lower abdominal pain is diagnosed easily and treated,as surgeon can view the whole abdominal cavity in laparoscopy.

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