Laparosopic Appendectomy

What is the appendix?

The appendix is a narrow, small, finger-shaped portion of the large intestine that generally hangs down from the lower right side of the abdomen.



If the appendix becomes infected (appendicitis), the infected appendix must be surgically removed (emergency appendectomy) before a hole develops in the appendix (perforation) and spreads the infection to the entire abdominal space (peritonitis).



What is appendicitis and what causes it?

Appendicitis is a sudden inflammation of the appendix. Although the appendix does not seem to serve any purpose, it can become diseased and, if untreated, can burst, causing infection and even death. The cause of appendicitis is usually unknown. Appendicitis may occur after a viral infection in the digestive tract or when the tube connecting the large intestine and appendix is blocked or trapped by stool. It is thought that blockage of the opening of the appendix into the bowel by a hard, small stool fragment causes inflammation and infection of the appendix (appendicitis). The inflammation can cause infection, a blood clot, or rupture of the appendix.

The infected appendix then must be surgically removed (emergency appendectomy) before a hole develops in the appendix and spreads the infection to the entire abdominal space.


What are the symptoms of appendicitis?

  • Abdominal pain -- pain may begin in the upper-middle abdomen then develop to sharp localized pain
  • Abdominal pain may be worse when walking or coughing
  • Fever usually occurs within several hours
  • Loss of appetite
  • Nausea
  • Vomiting
  • Constipation
  • Rectal Tenderness
  • Chills and Shaking

If you have these symptoms, see a doctor immediately! Because of the risk of rupture, which may happen as soon as 48 to 72 hours after symptoms begin, appendicitis is considered an emergency.


How is appendicitis treated?

The best treatment of appendicitis is its surgical removal. Mild appendicitis may sometimes be cured with antibiotics. More serious cases are treated with surgery to remove the appendix, called an appendectomy. Doctors either use an "open" technique or a minimally invasive approach to remove the appendix.

Appendicitis is considered an emergency and anyone with symptoms needs to see a doctor immediately!


WHAT IS A LAPAROSCOPIC APPENDECTOMY?

Appendicitis is one of the most common surgical problems. One out of every 2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall.

In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each ¼ to ½ inch) while watching an enlarged image of the patient's internal organs on a television monitor. In some cases, one of the small openings may be lengthened to 2 or 3 inches to complete the procedure.


ADVANTAGES OF LAPAROSCOPIC APPENDECTOMY

Results may vary depending upon the type of procedure and patient's overall condition. Common advantages are:

  • Less postoperative pain
  • May shorten hospital stay
  • May result in a quicker return to bowel function
  • Quicker return to normal activity
  • Better cosmetic results

ARE YOU A CANDIDATE FOR LAPAROSCOPIC APPENDECTOMY?

Although laparoscopic appendectomy has many benefits, it may not be appropriate for some patients. Early, non-ruptured appendicitis usually can be removed laparoscopically. Laparoscopic appendectomy is more difficult to perform if there is advanced infection or the appendix has ruptured. A traditional, open procedure using a larger incision may be required to safely remove the infected appendix in these patients.


HOW IS LAPAROSCOPIC APPENDECTOMY PERFORMED?

The words "laparoscopic" and "open" appendectomy describes the techniques a surgeon uses to gain access to the internal surgery site.

Most laparoscopic appendectomies start the same way. Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through a cannula, giving the surgeon a magnified view of the patient's internal organs on a television monitor. Several other cannulas are inserted to allow the surgeon to work inside and remove the appendix. The entire procedure may be completed through the cannulas or by lengthening one of the small cannula incisions. A drain may be placed during the procedure. This will be removed before you leave the hospital.


WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?

In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. Factors that may increase the possibility of converting to the "open" procedure may include:


  • Extensive infection and/or abscess
  • A perforated appendix
  • Obesity
  • A history of prior abdominal surgery causing dense scar tissue
  • Inability to visualize organs
  • Bleeding problems during the operation

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open procedure is strictly based on patient safety.


WHAT SHOULD I EXPECT AFTER SURGERY?

After the operation, it is important to follow your doctor's instructions. Although many people feel better in just a few days, remember that your body needs time to heal.

You are encouraged to be out of bed the day after surgery and to walk. This will help diminish the risk of blood clots in your legs and of soreness in your muscles.

You will probably be able to get back to most of your normal activities in one to two weeks time. These activities include showering, driving, walking up stairs, working and engaging in sexual intercourse.

If you have prolonged soreness or are getting no relief from the prescribed pain medication, you should notify your surgeon.

You should call your surgeon and schedule a follow up appointment for about 1-2 weeks following your operation.


WHAT COMPLICATIONS CAN OCCUR?

As with any operation, there are risks including the risk of complications. However, the risk of one of these complications occurring is no higher than if the operation was done with the open technique.

  • Bleeding
  • Infection
  • Removal of a normal appendix
  • A leak at the edge of the colon where the appendix was removed
  • Injury to adjacent organs such as the small intestine, ureter, or bladder.
  • Blood clot to the lungs

It is important for you to recognize the early signs of possible complications. Contact your surgeon if you have severe abdominal pain, fever, chills or rectal bleeding.


What is a laparoscopic appendectomy?

The laparoscopic (minimally invasive) surgical technique involves making several tiny cuts in the abdomen and inserting a miniature camera and surgical instruments. As many as three or four incisions are made. The surgeon then removes the appendix with the instruments, so there is usually no need to make a large incision in the abdomen. The camera projects a magnified image of the area onto a television monitor which helps guide the surgeons as they remove the appendix.


What is the benefit of laparoscopic appendectomy?

Most cases of acute appendicitis can be treated laparoscopically. The main advantages are:

  • Less post-operative pain
  • Faster recovery and return to normal activity
  • Shorter hospital stay
  • Less post-operative complications
  • Minimally sized incisions/scars

In most cases, patients can be discharged within 24 to 36 hours. By contrast, the hospital stay is typically two to five days for an open procedure.


Can every patient have a laparoscopic appendectomy?

No. Patients with cardiac diseases and COPD would not be good candidates for laparoscopic appendectomy. In addition, laparoscopic appendectomy is not recommended for those with pre-existing disease conditions.

Laparoscopic appendectomy may also be more difficult in patients who have had previous lower abdominal surgery and for obese patients. The elderly may also be at increased risk for complications with general anesthesia. We evaluate every patient to determine the appropriate type of surgery to perform.