Laparoscopic Appendectomy

Laparoscopic Appendectomy

The mention of the appendix is something almost everyone is familiar with to some extent. It refers to the large intestine's appendage that protrudes like a small finger on the right side. Its benefits may not be clear, and its purpose remains ambiguous. Perhaps it was given to us by a divine power, but one thing is certain: it has caused numerous problems for us. Whether it's infections, inflammation, or the growth of tumors.

When it comes to diseases related to the appendix, the most well-known is acute appendicitis. Acute appendicitis is a sudden, sharp abdominal pain that is most commonly experienced between the ages of 15 and 45 in both males and females. It is caused by a blockage in the appendix, which can result from any type of food, not necessarily the seeds of fruits as ancient folklore suggests (although seeds can also be problematic). It can also occur due to swelling of the lymphatic tissue in that area or when a piece of debris falls into it, causing an obstruction. When the opening of the appendix becomes blocked, fluid and secretions are unable to pass through, leading to inflammation and infection.

The symptoms of acute appendicitis include abdominal pain, which typically starts in the center and may initially be felt around the navel. After 6-12 hours, the pain tends to shift to the lower right side. Low-grade fever may also be present, but it usually does not exceed 38.5 degrees Celsius. However, these classic symptoms are only observed in approximately 25% of cases. In other cases, the symptoms may not be as clear. The pain may be felt in the upper right side or in the middle. If the appendix extends to those areas, the symptoms may not be distinctive. However, most patients commonly experience loss of appetite, inability to eat, some may experience nausea, vomiting, and loose stools. If left untreated, the symptoms may worsen, and the fever can rise above 39 degrees Celsius. The pain may be felt on both the left and right sides, indicating a severe, infected, necrotic, or ruptured appendix, and the duration of these symptoms depends on various factors such as the patient's age, the size of the appendix, and the treatment provided. Although some cases can be managed with conservative treatment, in general, once the pain starts and progresses to the point of rupture, it usually does not exceed three days.

The most definitive treatment for appendicitis, as we all know, is surgery. Surgery can be performed under general anesthesia or with a spinal block, commonly known as an epidural. After that, the surgeon will make an incision approximately 3-4 cm in size on the lower right side of the abdomen, where the appendix is located. The appendix is then removed, and the incision is closed. This is something surgeons have been doing for a long time, even before my memory serves me.

Currently, there is a trend in surgery to minimize pain and the severity of the procedure. One term we often hear is "Minimal Invasive Surgery," which can refer to various techniques. One of them is laparoscopic surgery, also known as keyhole surgery, which involves using a camera inside the abdomen to explore and specialized instruments to perform the surgery instead of using hands. Laparoscopic surgery has been used for various diseases, including appendicitis, gallstones, intestinal surgeries, hernias, and more.

The condition of appendicitis can be treated through a surgical procedure called laparoscopic appendectomy. Skilled and experienced surgeons utilize this method, which involves making small incisions below the navel and two additional small incisions under the clothed area to conceal the surgical wounds. The procedure itself is similar to a regular appendectomy, involving the removal of the appendix by cutting the blood vessels supplying it and placing it in a sterile bag to prevent contamination before removing it from the body.

The advantages of laparoscopic appendectomy include smaller incisions, less pain, and faster recovery. Even the hospital stay may not significantly differ from a regular appendectomy, but the overall recuperation is quicker with less discomfort, allowing patients to return to their daily lives sooner.

However, laparoscopic surgery does have certain limitations. In cases of severe appendicitis or when there is significant tissue adhesion, performing the procedure with a laparoscope may not be feasible. Additionally, the cost of laparoscopic surgery is higher compared to traditional open surgery.

While laparoscopic appendectomy is considered a standard procedure in many countries, in Thailand, it is only performed in select leading hospitals due to the requirement for specialized equipment and highly skilled surgeons who have received specific training. The expense associated with this type of surgery is higher than that of an open abdominal approach. Nevertheless, these drawbacks are outweighed by the satisfactory outcomes in terms of surgical wound aesthetics, reduced pain, and shorter recovery period.

The Surgical Department of Vipawadee Hospital is one of the hospitals that offers laparoscopic appendectomy services. For further information, please contact the Surgical Department at 02-941-2800, extensions 2137 and 2138.

Dr. Thanet Phuapornphong, M.D.

• Certificate Fellowship of Endoscopic and Laparoscopic Surgery, Imperial College, London, UK.
• Medical Degree, Faculty of Medicine Siriraj Hospital, Mahidol University.
• General Surgery Board Certification.
• Family Medicine Board Certification.