Laparoscopic Appendicectomy




 
What is laparoscopic appendicectomy?
What is the appendix? Can I live without it?
Who needs an appendicectomy?
What does a laparoscopic appendicectomy involve?
What are the advantages of the laparoscopic approach to appendicectomy?
 
What is laparoscopic appendicectomy?

This term refers to the removal of the appendix (appendicectomy) using keyhole surgery instead of an open operation.
 
What is the appendix? Can I live without it?

The appendix is a small, finger-shaped pouch that is located at the cecum (the junction between the large and small intestines). With the exception of some extremely rare circumstances, we do not need the appendix and can live normally without it.
 
Who needs to have an appendicectomy?

Acute inflammation of the appendix (appendicitis) is the most common indication for appendicectomy.

Patients admitted acutely to hospital with a rather long history of acute right lower abdominal pain (5 days or more) may be found to have a mass in the abdomen, called "appendicular mass". This is the result of the body's defence mechanisms, including the bowel and a fatty protective apron inside the abdomen called 'omentum' wrapping themselves around the inflamed appendix to stop the spread of infection to the rest of the body. Traditionally surgeons have treated such patients with antibiotics and have avoided surgery due to its considerably increased difficulty, and planned to remove the appendix, if necessary, some 2-3 months later wen the inflammation has all resolved. However, the inflammation may not settle and may progress in perhaps 1 of 5 patients. In addition, the inflammation may recur while someone is awaiting an appendicectomy. More importantly, what was thought to be an 'appendicular mass' may turn out to be something more serious that needs prompt surgery. For all these reasons, we have adopted an aggressive approach to the treatment of 'appendicular mass', and offer a laparoscopic appendicectomy to all these patients soon after their acute admission to hospital. You may read our publication on this matter by clicking on this link: Early laparoscopic appendectomy for appendicular mass.

Occasionally, at the time of the operation in someone who is suffering acutely with right lower abdominal pain suspicious of acute appendicitis, the appendix and the bowel appear normal. Under these circumstances, some surgeons elect to remove the appendix as there is a 1 in 4 or 1 in 5 chance of the appendix being inflamed when examined under the microscope. The significance of this microscopic inflammation of te appendix however is uncertain.

Some patients who have complained for a number of years with recurrent pain in the right lower abdomen that has rarely been severe enough to warrant an urgent admission to hospital may have what people call a 'niggling appendix'. They would commonly have undergone several investigations to find out the cause of the pain, and usually these tests prove normal. The elective removal of the appendix under these circumstances using the laparoscopic approach, a very low-risk procedure, may help some (perhaps less than half) of these patients.

Sometimes gynaecologists remove a normal appendix at the time of surgery on the womb (uterus) or the fallopian tubes. The benefit of such an 'incidental' appendicectomy however is not clearly established.
 
What does a laparoscopic appendicectomy involve?

This operation is performed under general anaesthesia. An instrument called the laparoscope, a long tube with a lens at one end and a miniature video camera at the other, is inserted into the abdomen through a small incision adjacent to the navel. The appendix and the rest of the bowel are examined using instruments introduced through two other 5 mm incisions. The appendix is removed and placed into a water-proof bag before its extraction from the abdomen in order to prevent contact between the inflamed appendix and the skin, which avoids the risk of wound infection.

Although conversion to an open operation ma become necessary if there are difficulties with the operation, our conversion rate remains less than 1% for all comers with acute appendicitis, including patients with perforated appendicitis and generalised abdominal inflammation (peritonitis).
 
What are the advantages of the laparoscopic approach to appendicectomy?

Several randomised controlled trials have demonstrated that the laparoscopic approach is associated with less postoperative pain, less incidence of wound complications, and a more rapid recovery and return to full activity compared with open appendicectomy. In addition, the laparoscopic approach is associated with considerably less formation of adhesions between the intestine and the abdomen; these adhesions may cause obstruction of the bowel in some patients, and may

Further Reading:
  → Laparoscopic vs conventional appendectomy-a meta-analysis of randomised controlled trials.
  → Randomized clinical trial of laparoscopic versus open appendicectomy.
  → Single-blind randomized clinical trial of laparoscopic versus open appendicectomy in children.
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