Laparoscopic Appendectomy

In this article, I want to go over the laparoscopic appendectomy for those of you who would like to know more about the procedure itself.

The treatment for appendicitis is an operation to remove the appendix. Plain and simple. For most people, antibiotics just won’t work, and an operation to remove the appendix‚ called an “Appendectomy” is needed. (ectomy is Latin for “removal”)

There are two types of Appendectomies.  First is the “old-fashioned way”, where the surgeon makes an incision 4-5 inches long over the spot where you have the pain (in the right lower abdomen). This is a safe way to have an appendectomy, but often it causes more pain than a Laparoscopic Appendectomy.

Description of the Laparoscopic Appendectomy: The patient is first put to sleep by an anesthesiologist.  After securing the patient to the operating table, the abdomen is cleaned and “prepped” with a solution to remove as much bacteria from the skin as possible to decrease the risk of infection.  Sometimes a catheter is placed in the bladder to decompress the bladder for better visualization of the abdominal organs.  Next, a 12 millimeter incision is made just below or in the belly button.  This give access to the abdomen.  CO2 gas is then placed in the abdomen so there is room to see.  A port is placed in the belly button incision, and a camera is placed through the port into the abdomen.  Two other ports are placed.  In most of my operations, I place these in the lower abdomen, and the left lower abdomen.  Then small instruments are placed through these ports into the abdomen and the appendix is found.  Once it is found, it’s attachments are removed from the surrounding structures.  Sometimes the appendix is very inflamed and “sticks” to other organs or the abdominal wall.  Other times the appendix is free.  After it is freed, the artery to the appendix is found and either cut with a heat producing device, or tissue stapler.  Next, sutures or a stapling device is placed at the base and then the appendix is cut in half just after the sutures or staple.  Once the appendix is freed, a small plastic bag is placed in the abdomen and removed through one of the incision sites.  If the appendix was grossly infected and there is bacteria all over the abdomen or pelvis, the abdomen and pelvis is washed thoroughly with a saline solution.  After inspection of the abdomen, the incisions are closed and dressings applied.  The patient is woken from the anesthesia and taken to the recovery room to continue waking.

There are of course a few risks associated with an appendectomy that you should know so you are completely informed about your operation before you have it. Anytime we do any procedure there are risks associated with that procedure. Even a procedure as small as taking a few drops of blood can have risks. But, there are some specific risks to the appendectomy I’d like to discuss. Just as any surgery, the two most common risks of an Appendectomy are bleeding and infection. Bleeding can be mild and self limiting‚ meaning it stops on it’s own‚ or it can be moderate….as you may require a blood transfusion..or severe as you may require an additional operation to stop the bleeding. Second is infection. Infections can also be mild, moderate or severe with treatment ranging from antibiotics, to opening the incision, to another operation. Since we are moving the bowels around when we take out the appendix, the bowels can become injured. If it is recognized right away, they can be fixed most of the time without additional incisions during the same operation. If it is not recognized until after the operation, an additional operation to fix the bowels will be required. The bladder is also at a small risk of being injured, and the treatment is usually continuation of a bladder catheter for 3-5 days. Other than those risks, there are always risks of anesthesia, which depending on your health, may be anywhere from minor to severe. The anesthesiologist will speak to you about your specific anesthesia risks before the operation.

After your operation most patients are admitted to the hospital for overnight observation. The majority of patients return home in about 24 hours after arrival to the hospital. As long as you are eating OK, your pain is controlled with pain pills and you are walking OK, you can be discharged home. Some people experience nausea associated with the anesthesia during the operation, and if you are still nauseated and are unable to swallow pain pills and eat regular food, then you’ll need to stay a bit longer in the hospital until that clears up.