Laparoscopic Surgery in Abdomen (Appendicitis) Implications and Techniques

 

Laparoscopic Surgery in Abdomen

In the lower right part of the abdomen is a small, closed, and intestinal tube called appendix. Inflammation of the appendix, known as appendicitis, often comes on suddenly. Appendicitis is further common in youngsters and young adults. In most cases, urgent operation needed to prevent the appendix from rupturing in the abdomen. During the operation, called an appendectomy, the inflamed appendix is surgically removed. 

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The traditional surgical approach is to make a small incision (about 5 cm) in the lower right part of the abdominal wall. This operation can also be performed laparoscopically. This intervention, known as Laparoscopic appendectomy, requires three very small incisions (approximately 1 cm each). The surgeon then penetrates a camera and apparatuses into the abdomen and eradicates the appendix as in the typical procedure.

This review analyzed 67 clinical studies in which the surgical technique (traditional open surgery or laparoscopic) used for each patient was determined at random. The majority of studies were in adults, but there were also 7 studies in children. The main advantages of laparoscopic appendectomy, compared to the conventional procedure, were the reduction in the risk of wound infection, postoperative pain, length of hospital stay (-1 day), as well as than faster resumption of normal activities. 

The identified disadvantages of laparoscopic appendectomy were longer operating time (+10 minutes) and a higher rate of intra-abdominal abscess. The results in children were similar to those seen in adults. The ability to inspect the inside of the abdomen is an added benefit of the laparoscopic approach. Particularly in women of childbearing age, in whom many other disorders can resemble appendicitis, laparoscopy reduces the risk of unnecessary appendectomy.

Summary

Laparoscopic surgery for suspected appendicitis has diagnostic and therapeutic advantages over conventional surgery. However, classical appendectomy should not be considered bad, as the differences between the two techniques are relatively small and depend to a large extent on the characteristics of the patient and the expertise of the treating surgeon.

Implications for Practice

Although the total effects of minimally invasive surgery for suspected appendicitis are impressing. One must not overlook that most of the laparoscopic surgeons involved in these trials were well‐skilled specialists in laparoscopy. Therefore, surgical expertise with laparoscopic techniques is a basic prerequisite before surgeons can justly expect clinical benefits from laparoscopic appendectomy. The still continuing distribution of the various laparoscopic techniques, however, extracts it likely that the majority of upcoming surgeons will be capable to obtain training more easily.

Inside the same process, laparoscopic equipment is becoming more and more obtainable as well. This is important, since the routine availability of laparoscopic devices even in night hours is essential. Comparably, the working expenses will possibly decrease.

In those clinical settings where surgical expertise and equipment are available and affordable, we would generally recommend to use laparoscopy and laparoscopic appendectomy in all patients with suspected appendicitis unless laparoscopy itself is contraindicated or not feasible. This recommendation, however, does not pertain to perforated or gangrenous cases, since intra-abdominal abscesses are more likely to occur after laparoscopic appendectomy. In general and there is some evidence that such cases run a higher risk. 

Conclusion

Since the overall benefits of laparoscopic appendectomy are very small, those who continue to operate on appendicitis by conventional techniques might continue to do so, but laparoscopic surgery should routinely be working at least in special cases, for instance young female or obese patients, because the diagnostic and therapeutic advantages of laparoscopy are clearly larger in these cases.

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