Acute appendicitis is one of the most common diseases in surgery, with an incidence of about 1 in 1,000. If not treated promptly, acute appendicitis can also lead to serious consequences (necrotic perforation of the appendix, diffuse peritonitis, abdominal abscess), especially in the elderly, women and children.
Although conservative treatment of acute appendicitis can lead to remission in some patients, it is prone to recurrent attacks and ultimately requires surgical removal of the appendix to completely cure appendicitis. Therefore, appendectomy has always been regarded as the best treatment for appendicitis. In recent years, with the rise of laparoscopic technology, there is a new option for the treatment of appendicitis – laparoscopic appendectomy. It basically abolishes open surgery.
Why is laparoscopic appendectomy gaining more and more popularity?
First, appendicitis can be very complicated
Appendicitis is mostly an acute attack and is one of the most common surgical emergencies. Despite the rapid development of modern medical technology, the diagnosis and treatment of complex appendicitis is still a challenge. The diagnosis of simple appendicitis is not difficult if the clinical manifestations are typical, but there are always some patients with atypical clinical manifestations, and a small appendix is difficult for the doctor.
The diagnosis of appendicitis relies heavily on the physician’s judgment: symptoms and physical examination. The typical clinical presentation of acute appendicitis is a gradual onset of periumbilical pain, which shifts to a more fixed location in the right lower abdomen after a few hours. The most pronounced pressure pain is found in the right lower abdomen at the outer third of the line between the umbilicus and the anterior superior iliac spine, a point known as the “McDonald’s point”, which is a body projection of the appendix root. Doctors can determine appendicitis mainly by the typical medical history, the pressure pain at the McDonald’s point and the elevated white blood cells.
Second, there are many diseases similar to appendicitis
Since the right ureter and ovary are anatomically located close to the appendix, right ureteral stones, gynecological diseases on the right side (ovarian cyst torsion, adnexitis, follicular rupture, ectopic pregnancy, etc.) may also have symptoms similar to appendicitis with pain in the right lower abdomen, which are difficult to distinguish from appendicitis. Although the appendix is small, it is not easy to diagnose.
Third, the location of appendix varies greatly
The appendix has to rotate and descend in the abdominal cavity during embryonic development to reach its final position in the lower right abdomen. Therefore, the location of the appendix varies from person to person. A low appendix can be located in the pelvis, while a high appendix can be located in the liver. Therefore, there are often atypical areas of pain that interfere with the determination of the condition during an appendicitis attack. Even when the appendix is in a normal high or low position, the symptoms are very different. Since the appendix is only connected to the cecum at the root, which is relatively fixed, while the location of the head end is not fixed and can be both front and back, the wide variation in location not only makes diagnosis difficult, but also makes surgery difficult.
Fourth, what to do? Laparoscopy can help!
The development of surgical laparoscopic technology has brought great help to the diagnosis and treatment of acute abdominal disease. In addition to detailed analysis of the medical history, laparoscopic surgery is also a good adjunct in the management of acute abdominal disease. Laparoscopy can be used to explore the entire abdominal cavity to determine if appendicitis is the cause of the acute abdomen if there are surgical pointers. The laparoscopic investigation can be done from the liver down to the pelvis, so that the lesion can be seen clearly and misdiagnosis and misdiagnosis can be avoided.
Open surgery for appendicitis usually involves only a small incision, and the appendectomy can be completed without any problem if it goes well. However, in practice, we often encounter complicated situations, where a small incision is firstly not explored and judged, and it is easy to miss the diagnosis and judgment, and it is even more difficult for many doctors to encounter a small incision with a bad appendix position. This is the disadvantage of open appendicitis surgery, while laparoscopic surgery fully demonstrates its advantages in exploring and dealing with complex appendicitis.
V. Laparoscopic appendectomy versus traditional open appendectomy
The advantages of laparoscopic appendectomy are not simply in the incision, but also in the diagnosis, management of complex appendix and postoperative recovery.
Traditional surgery is usually performed with epidural anesthesia, and an incision of about 75px is made above the appendix in the lower right abdomen to enter the abdominal cavity and remove the appendix directly, which is difficult to grasp accurately the situation inside the abdominal cavity by the naked eye due to the incision, and it is difficult to deal with atypical cases, and once a complex appendix is encountered, it is often very passive, knowing that it is difficult to imagine what is going on inside until the belly is opened.
Laparoscopic appendectomy generally uses general anesthesia and involves three small holes in the belly: the larger hole is about 25px below the navel for putting in the camera and removing the appendicitis; the smaller hole is about 5mm for special instruments to complete the appendectomy in the abdominal cavity. The laparoscope has a high-definition camera system that allows observation and diagnosis of all corners of the abdominal cavity, and is not limited to the removal of appendixes in variant locations.
1.Aesthetic incision: First and foremost, the most well-known feature of laparoscopic surgery is the minimally invasive, small and beautiful incision. The incision of open surgery has an obvious incision scar, which is difficult to accept for many ladies who love beauty. The laparoscopic surgery, the incision scar is much lighter, the site hidden, and can not even be seen on the abdominal wall scars.
2, reduce post-operative pain: a large part of the pain after open appendectomy stems from the incision. Because the incision during appendicitis, the epidermal part is cut with a scalpel, and the deep abdominal wall muscle tissue is bluntly pulled apart, the blunt trauma is much greater than the sharp, so it is painful after surgery. Laparoscopic surgery is a perforated hole, and patients have less complaints of pain after surgery. Therefore, patients after laparoscopic appendectomy will have an easy time getting out of bed the next day; patients after open surgery must be gritting their teeth to get out of bed the next day.
3.Reducing incisional infection: incisional infection or liquefaction after open appendectomy is the most common postoperative complication: open appendectomy requires raising the appendix through the incision to the abdominal cavity for removal, and the inflamed appendix has a high probability of touching the sterile incision itself, especially for patients who are obese or have diabetes mellitus, which is more prone to infection. In contrast, in laparoscopic surgery, the appendix does not touch the incision, so there are few incisional infections, and even if there is an infection, the degree of infection is far less than in open surgery, and it is much easier to recover.
4. Thorough flushing: Open surgery is limited by the incision, and appendectomy cannot be performed with abdominal flushing because the saline used for flushing may not be completely sucked out, which will cause the spread of inflammation. However, the inflammatory exudate caused by appendicitis is bound to have more or less part of it remaining in the abdominal cavity, which is one of the reasons for the high incidence of intestinal adhesions, intestinal obstruction and abdominal abscess after appendectomy. During laparoscopic surgery, sufficient flushing can be performed, and there is absolutely no need to worry about the residual flushing fluid caused by the visual field problem.
5, fast postoperative recovery: traditional surgery generally requires about a week after surgery to remove stitches, while laparoscopic surgery does not require stitches to be removed. Patients with laparoscopic appendectomy are routinely discharged three days after surgery, while patients with open appendectomy are rarely discharged three days after surgery. In addition to less postoperative pain, this is also attributed to the advantages of thorough flushing of the clean abdominal cavity, less incisional infection and less interference with the gastrointestinal tract.