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Laparoscopic Appendectomy

Appendicitis is a common intra-abdominal pathology that requires operative management. Acute appendicitis is a progressive blockage of the appendix, which causes tissue inflammation. Appendicitis is a medical emergency and appendectomy its only treatment. Some common etiologies of appendicitis are the occurrence of lymphoid hyperplasia following IBD leading to luminal obstruction, fecal debris within the appendix, bacterial infections due to Yersinia species, cytomegalovirus, adenovirus, etc.

Indications for appendectomy

Patients present a history of persistent abdominal pain, signs of diffuse peritonitis with leukocytosis and fever. Tests may include CBC, C – reactive protein, Urinalysis, CT scan, ultrasonography and abdominal radiography. A rectal Gastrogafin enema or oral contrast medium with CT scan will show signs of atypical appendicitis under direct visualization. A non-compressible tubular structure is visualized clearly by ultrasonography. CT scans are equipped with superior sensitivity and possess accurate imaging techniques.

Technique

Laparoscopic appendectomy is an improved and standardized methodology as against open appendectomy. Aesthetic results are better with lower occurrences of dehiscence.

  • Patient is administered general anaesthesia
  • An endotracheal intubation is performed to assist respiration
  • Three cannulae are used during the procedure – two are fixed in the umbilical and suprapubic position while one is placed in the right periumbilical region
  • A small and short umbilical incision is made
  • The Hasson cannula is placed
  • 10-14 mm Hg pneumoperitoneum is established
  • Carbondioxide is insufflated and maintained
  • A laparoscope is inserted through the access
  • The entire abdominal cavity is viewed
  • Instruments such as incisors, forceps and staplers are inserted after the placement of a 12-mm trocar
  • A 5-mm trocar is placed in the periumbilical region
  • An atraumatic grasper is inserted, which exposes the appendix
  • The appendix is retracted upward; this allows exposure of the mesoappendix
  • A dissector is inserted through the suprapubic trocar
  • The mesoappendix is then divided and ligated with the help of a linear endostapler or suture ligature that is passed through the suprapubic cannula
  • Scissors or electrocautery is used to transect the mesoappendix
  • A linear endostapler is then used to transect the appendix; the surgeon may even choose suture-ligature
  • The freed appendix is removed through the suprapubic cannula
  • It is dropped into a laparoscopic pouch to avoid infections
  • The cannulae are extracted, pneumoperitoneum reduced, and sites closed with absorbable sutures

Dr. Deepak provides excellent outcomes whether the appendix is simple with gangrene or complicated with perforations. He ensures holistic treatments with patients returning to their normal activities almost immediately after the operation.

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