Appendix Procedure
Laparoscopic Appendicectomy?

What is Appendix?
The appendix is the narrow small finger shaped portion of large intestine, the generally hangs down from the lower right side of abdomen where small intestine joins the large intestine.

What is appendicitis?

Appendicitis is the 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. If appendix becomes infected, (in appendicitis), the infected appendix must be surgically removed (emergency appendicectomy) before a hole develops the appendix (perforation) and spreads infection to entire abdomen (peritonitis)

What are causes of appendicitis?

The exact cause of appendicitis is unknown. It may occur after a viral infection. It may also occur when the mouth is blocked by stools (Faecolith).

What are symptoms experienced due to appendicectomy?

Abdominal pain in right lower abdomen
It may worsen during walking or coughing
Fever usually occur within several hours
Loss of appetite
Nausea
Vomiting
Constipation
Chills/Shaking
 
If you have these symptoms, see doctor immediately, because of the risk of rupture which may happen as soon as 48-72 hrs after symptoms have begun. Appendicitis is a surgical emergency.

How is appendicitis diagnosed?

It is essentially a clinical diagnosis. There is no laboratory test or radiological test, yet that is 100%diagnostic.USG and CT scan done by a good radiologist has an accuracy of greater than 90% but it may be negative. Diagnostic laparoscopy has a sensitivity and specificity of 100%.

What are Treatment options available for Appendicitis?

The best treatment for appendicitis is surgical removal. Mild appendicitis may sometimes be cured with antibiotics. Such patient may require removal of appendix at later date to prevent recurrence of symptoms. This is called interval appendicectomy. More serious cases are treated with surgery to remove appendix called appendicectomy. Doctors use either a open technique or laparoscopy to remove appendix.

What is Laparoscopic Appendicectomy?

It involves making a tiny incision in the abdomen and removing appendix through it. Patient receives general anaethesia. The small incision is made at  the naval and thin  tube carrying the video camera is inserted .The surgeon inflates the abdomen with co2,a harmless gas, for ensuring viewing and to provide room for surgery to be performed .Next two instruments are inserted which serve as tiny hands within the abdomen. They can pick up the appendix, move intestine and assist the surgeon. The instruments clears fat around the appendix, controls bleeding and ligate the base of appendix. They help to cut the appendix and it is then removed from tiny naval incision

How I prepare for a Laparoscopic Appendicectomy?

First of all give a complete list of all medicines your taking as well as any allergies you have to drugs and other substances. Let your doctor know if you have heart, lung or other medical conditions that may need specific attention before during or after surgery. One very important step in preparing for surgery is that you should not eat or drink within 6-8 hrs. of your surgery.

The procedure will done on IPD basis. You can be admitted on day of surgery in the morning or one day in advance before surgery. Get a family member to accompanying you for the surgery. You will be seen by an anesthetic. You will require signing a consent form for the surgery.

What can you expect during the surgery?

During the surgery everything will be done to ensure your comfort. The procedure will be performed under general anaethesia. It will make you relax and sleepy thus preventing you from remembering much of the experience. Your blood pressure, pulse, oxygen level in the blood will be carefully monitored. Details of laparoscopic Appendicectomy have already been explained to you. Operation is typically over in about 45 minutes to an hour, depending upon the operative findings. Post operation bandages will be put at the site of surgery which being vary small.

What can your expect after Laparoscopic Appendicectomy?

Once the operation will over, you will be shifted in the recovery room. In the recovery you will remain drowsy and sedative. Your blood pressure, pulse and oxygen saturation will be monitored. In the recovery room sister will keep strict watch on you. Once you are totally alert, and again reviewed by anesthetics you will be shifted your respective room. Post-operatively surgeon will visit you in the room and will give necessary instructions for your oral intake and other activities.

What are post-operative orders to be followed?

Post appendicectomy you will kept fasting for a minimum period of 6 hours. The period of fasting may be increased depending upon how severely inflamed the appendix was. The operating surgeon would see you within 6 hours and advised regarding oral intake. During the period of fasting you will receive IV antibiotics, pain killers and IV fluids. Once oral intake is resumed, depending upon your bowel movements as judged by your surgeon, you will be full normal diet and ready for discharged.

What are the possible complications?

Even though infrequent, it still carries same risk as open surgery.

What are the benefits of Laparoscopic appendectomy?

Less post operative pain
Faster recovery and return to normal activity
Shorter hospital stay
Minimally sized incision
Allows through exploration of the abdominal cavity

Can every patient undergo Lap Appendicectomy?

No. Patient with cardiac disease and COPD are usually no good candidates. Also patient on radiotherapy and immunocompromised cannot undergo this procedure. 

 
 
 
Director's Corner
DR. SUSHIL LOHIYA
M.B.B.S., M.S.
General Surgery
(Sion, Mumbai)
Fellow in Bariatric & Metabolic Surgery
 
 
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