General Surgery

Open and Laparoscopic Appendectomy

Appendectomy is the medical terminology for the removal of the vermiform appendix (a small sac of tissue that is located in the first part of the colon) also most commonly known as appendix. It is done in a condition called as Appendicitis (inflammation of appendix).

What is Appendicitis?

Appendicitis is a condition where, there is an inflammation of the appendix, which can occur anytime in severe form leading to acute appendicitis.

Causes of Appendicitis

Some of the most common causes for appendicitis are Racial and dietary factors, familial causes, socioeconomic causes, obstructive causes due to the worms, eggs of the parasites, adhesion of the fecal mass and the entamoeba cysts and non-obstructive causes such as E.coli, Enterococci, Proteus, Pseudomonas, Klebsiella and anaerobes can result in the inflammation of the appendix.

Symptoms of Appendicitis

The signs and symptoms are severe colicky pain in the umbilical region which radiates to the right iliac fossa (Murphy’s triad), vomiting of stomach contents, low grade fever, blood in the urine and constipation. And the most characteristic sign of appendicitis is cough tenderness and rebound tenderness at the right side of the abdomen.

Complications of Appendicitis

If acute appendicitis is not treated early, then it can lead to the life threatening conditions such as ruptured appendix or appendicular abscess.

Diagnosis

The diagnosis of the appendicitis is done from the blood investigations, X-ray abdomen and abdominal ultrasonography to rule out the associated gynecological conditions and other abdominal perforations.

Treatment

Appendicitis is managed by the surgical procedure called Appendectomy. There are two types of appendectomy;

  • Open Appendectomy
  • Laparoscopic Appendectomy

Open Appendectomy

Is the traditional method of removal of appendix by making an incision over the McBurney’s point (right side of abdomen). Then the skin and the two layers of subcutaneous tissues are opened to reach peritoneum, where it is further incised to reach the appendix. Then the attached blood vessels and tissues are separated and a purse string suture is applied round the inflamed appendix then it is crushed at the base and above 1cm of the crushed base the ligation is done and the appendix is cut and removed. Then the stump is cleaned and the string suture is tightened. Then layer by layer closure sutures are done.

Laparoscopic Appendectomy

is the minimal surgical invasion of removing the inflamed appendix. The laparoscope is attached with the high resonance camera, which is then inserted at the operated site for the maximum enlarged view. In this procedure the two small holes are drilled, then the long incisions are done, to reach the peritoneum layer (lining of the abdominal cavity). Then reaching the site of appendix, all the blood vessels are detached and the appendix base is stapled and then by electrocauterization appendix is separated and removed. The area of incision is closed.

Advantages of Laparoscopic Appendectomy over Open Appendectomy

  • Minimal scar at the operated site.
  • Recovery period is very early, patient can resume to the work within few days of surgery.
  • Injury to the tissues and the inner organs are reduced.

Laparoscopic Cholecystectomy
open and laparoscopic appendectomy
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