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Laparoscopic Appendectomy

What is Appendix

Extending from the inferior end of the large intestine’s cecum, the human appendix is a narrow pouch of tissue whose resemblance to a worm inspired its alternate name, vermiform (worm-like) appendix. It is located in the right iliac region of the abdomen (in the lower right-hand abdominal area), measuring about four inches long and roughly a quarter of an inch in diameter. The appendix produces a bacteria destroying protein called immunoglobulins, which help fight infection in the body. Its function, however, is not essential. People who have had appendectomies do not have an increased risk toward infection. Other organs in the body take over this function once the appendix has been removed.

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. The inflammation can cause infection, a blood clot, or rupture of the appendix.

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

What is an appendectomy?

An appendectomy is surgery to remove the appendix when it is infected. This condition is called appendicitis. Appendectomy is a common emergency surgery. The appendix is a thin pouch that is attached to the large intestine. It sits in the lower right part of your belly. If you have appendicitis, your appendix must be removed right away. If not treated, your appendix can burst. This is a medical emergency.
laparopscopic Appendectomy

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.

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. 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.

How is a 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 later by your surgeon.

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. If your 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

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.