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

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 burst, 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, or rupture of the appendix.

The infected appendix then must be surgically removed (emergency appendectomy) before a hole develops in the appendix and spreads the infection to the entire abdominal space.

• Abdominal pain – pain may begin in the upper-middle abdomen, developing into sharp localised pain
• Abdominal pain may be worse when walking or coughing
• Fever usually occurs within several hours
• Loss of appetite
• Nausea
• Vomiting
• Constipation
• Rectal tenderness
• Chills and shaking

Several ways have been suggested to diminish the diagnostic error that occurs if diagnosis is based solely on the clinical picture of suspected appendicitis. In fact appendicitis is a disease, which can mimic most of the causes of abdominal pain as well as some of the chest diseases. Despite new x-ray techniques, CT scans and ultrasounds, the diagnosis of appendicitis can be quite challenging. So far the most accurate non-invasive method of diagnosis is ultrasonography but this is not totally reliable. The history and physical examination will generally lead to the correct diagnosis.

• The best treatment of appendicitis is surgical removal. Mild appendicitis may sometimes be cured with antibiotics. More serious cases are treated with surgery to remove the appendix, called an appendectomy. Doctors either use an “open” technique or a minimally invasive approach to remove the appendix.
• Appendicitis is considered an emergency and anyone with symptoms needs to see a doctor immediately!

The laparoscopic (minimally invasive) surgical technique involves making several tiny cuts in the abdomen and inserting a miniature camera and surgical instruments. As many as three or four incisions are made. The surgeon then removes the appendix with the instruments, so there is usually no need to make a large incision in the abdomen. The camera projects a magnified image of the area onto a television monitor which helps guide the surgeons as they remove the appendix.

Most cases of acute appendicitis can be treated laparoscopically. The main advantages are:

• Less post-operative pain
• Faster recovery and return to normal activity
• Shorter hospital stay
• Less post-operative complications
• Minimally sized incisions/scars

In most cases, patients can be discharged within 24 to 36 hours. By contrast, the hospital stay is typically two to five days for an open procedure.

No. Patients with cardiac diseases and COPD would not be good candidates for laparoscopic appendectomy. In addition, laparoscopic appendectomy is not recommended for those with pre-existing disease conditions.

Laparoscopic appendectomy may also be more difficult in patients who have had previous lower abdominal surgery and for obese patients. 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.

In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. Factors that may increase the possibility of converting to the “open” procedure may include:

• Extensive infection and/or abscess
• A perforated appendix
• Obesity
• A history of prior abdominal surgery causing dense scar tissue
• Inability to visualize organs
• Bleeding problems during the operation

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open procedure is strictly based on patient safety

In an experienced hand, there are no specific complications directly related to laparoscopic procedure. However, if the surgeon is not trained in laparoscopy, then the chances of complications are listed below:

• Missed diagnosis
• Bleeding
• Incomplete appendectomy
• Visceral Injury
• Leakage of purulent exudates from appendix at the time of operation:
• Intra-abdominal abscess
• Hernia