SINGLE INCISION LAPAROSCOPIC APPENDECTOMY

What is the Appendix?

 

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

- If the appendix becomes infected (appendicitis), in most cases 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).

 

- It may also progress to gangrenous with risk to life and thus the important to have an appendicitis seen to immediately.

What is Appendicitis?

 

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 rupture, 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 (may lead to portal vein thrombosis), or rupture the appendix.

Signs & Symptoms

 

  • Dull pain near the navel or the upper or lower abdomen that becomes sharp as it moves to the lower right abdomen; this is usually the first sign, but it occurs in less than half of appendicitis cases.

  • Loss of appetite

  • Nausea or vomiting soon after abdominal pain begins

  • Abdominal swelling

  • Temperature of 100 to 101 degrees Fahrenheit

  • Constipation or diarrhea with gas

  • Inability to pass gas

  • Painful urination

How do you know if it’s something to worry about?

 

Call Your Doctor About Appendicitis if you have any of the symptoms listed above. Acute appendicitis is a medical emergency that can be fatal. Prompt surgery is often essential. Do not eat, drink, or use any pain remedies, antacids, laxatives, or heating pads, which can cause an inflamed appendix to rupture.

 

  • You have symptoms of appendicitis, but your appendix has already been removed; you may have:

    • Pelvic inflammatory disease

    • Diverticulitis

    • A tubal pregnancy

    • Gastroenteritis

    • Inflammation of your colon, called colitis or Crohn's disease, or Colorectal cancer.

 

    Seek medical care immediately.

 

  • After an appendectomy, call your doctor right away if you have:

    • Persistent vomiting

    • Continued pain in your abdomen

    • Dizziness/feelings of faintness

    • Blood in your vomit, urine, or stool

    • Fever

    • Diarrhea

How is Appendicitis diagnosed?

 

Your doctor will begin by performing a physical exam. A physical exam for appendicitis looks for tenderness in the lower right quadrant of your abdomen. If you’re pregnant, the pain may be higher. If perforation occurs, your stomach may become hard and swollen. A swollen, rigid belly is a symptom that should be discussed with a doctor right away. In addition to looking for tenderness, your doctor will perform several tests for appendicitis:

 

  • Urinalysis can rule out a urinary tract infection or kidney stone.

  • Pelvic exams can make certain that women don’t have reproductive problems.  They can also rule out other pelvic infections.

  • Pregnancy tests can rule out a suspected ectopic pregnancy.

  • Abdominal imaging can determine if you have an abscess or other complications. This may be done with an X-ray, ultrasound, or CT scan.

  • Chest X-ray can rule out right lower lobe pneumonia. This sometimes has symptoms similar to appendicitis.

Treatment Options

 

Treatment for appendicitis varies.

In rare cases, appendicitis may get better without surgery. Treatment might involve only antibiotics and a liquid diet. In most cases, however, surgery will be necessary.

 

The type of surgery will depend on the details of your case. If you have an abscess that hasn’t ruptured, you may receive antibiotics first. Your doctor will then drain your abscess using a tube placed through your skin. Surgery will remove your appendix after you’ve received treatment for the infection.

 

If you have a ruptured abscess or appendix, surgery may be necessary right away. Surgery to remove the appendix is known as an appendectomy. A doctor can perform this procedure as open surgery or through a laparoscopy.

 

Single Incision Laparoscopic Appendectomy (SILS Appendectomy) is performed through a single, small incision within the belly button. Camera and instruments are inserted through the same hole and surgery is conducted through the single hole. The infected specimen (appendix) is removed through the same hole. As the cut is closed with absorbable sutures, not visible on the outside, there are no obvious visible scars as the wound heals. There is also no need to remove any sutures.

 

Most cases of acute appendicitis can be treated by means of single incision laparoscopic surgery (SILS). The main advantages include:

 

  • Less pain

  • Faster recovery and return to normal activity

  • Shorter hospital stay

  • Less wound related complications due to less number of surgical cuts

  • Surgery scar is hidden within the umbilicus (naval)

 

In most cases, patients can be discharged within 24 to 36 hours. In comparison, an open procedure requires the patient to stay in the hospital for two to five days.

 

Most patients (more than 95% of patients) can have single incision laparoscopic Appendicectomy. However, SILS Appendectomy may be more difficult in patients who have had previous lower abdominal surgery and in the cases of obese patients. Within this group of patients, there is a possibility of conversion to 4 key-hole or open surgery. 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. 

 

Prevention

 

You can’t prevent appendicitis, but there are steps you can take to lower your risk. It’s less common in people who have diets high in fiber. Eating a healthy diet that contains lots of fresh fruits and vegetables increases your fiber intake.

Seek medical attention immediately if you think you have appendicitis. Untreated appendicitis can become a medical emergency.