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Laparoscopic Appendicectomy

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27/01/2007

This term refers to the removal of the appendix (appendicectomy) using keyhole surgery instead of an open operation.

The appendix is a small, finger-shaped pouch that is located at the cecum (the junction between the large and small intestines).  We do not need the appendix and can live normally without it.

Who needs to have an appendicectomy?

  • Acute inflammation is the commonest indication for appendicectomy.
  • Patients with a long history of acue right lower abdominal pain (5 days or more) may have developed a mass in the abdomen - appendix mass.  This is the result of the body's defence mechanisms, bowel and a fat inside the abdomen, wrapping themselves around the inflamed appendix to stop the spread of infection.

Traditionally this latter group of patients are treated with antibotics and surgery avoided untill the inflammation has all resolved, 2-3 months later. However, in some cases the inflammation may progress or recur whilst awaiting an appendicectomy. More importantly, what was thought to be an 'appendicular mass' may turn out to be something more serious that requiress prompt surgery.

For these reasons, we have adopted an aggressive approach to the treatment of 'appendicular mass' and offer a laparoscopic appendicectomy to all these patiens during their acute admission.



What does a laparoscopic appendicectomy involve?

The operation is performed under general anaesthesia.  Antibiotics are administered intra venously and an injection is given to reduce the risk of thrombosis.  A laparoscope, a long tube with a lens at one end and a miniature video camera at the other, is inserted into the abdomen through a small incision within the navel.  The appendix and the rest of the bowel are examined using instruments introduced through two other 5 mm incisions within the pubic region.  The appendix is removed and placed into a water-proof bag before its extraction from the abdomen through the umbilicus.  Occassionaly a small drain is left in the pelvis.

Although conversion to an open operation may become necesary if there are difficulties with the operation, BLAs conversion rate remains less than 1% for all comers
, including patients with perforated appendicitis and generalised abdominal inflammation (peritonitis).

Most patients are discharged home the next day with a supply of paracetamol and diclofenac for pain relief.  We place no restrictions on activity - do what you want.  Your body will tell you if you are doing too much.  Most people can return to work within a week.


What are the advantages?

Several randomised controlled trials have demonstrated that the laparoscopic approach is associaed with less postoperative pain, fewer wound complications and a more rapid recovery and return to full physical activity compared with open surgery. In addition, the laparoscopic approach is associated with considerably less formation of adhesions betwen the intestine and the abdomen; these adhesions may cause obstruction of the bowel in some patients.


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SPIRE Hospital, Bristol. 
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Contact: Claire Trenberth - 0117 9804051
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