Appendicitis is difficult to diagnose Appendicitis is a common surgical condition, most common in young people and more common in men than women. Acute appendicitis is more common clinically, with an incidence of about 1 in 1,000, and surgical resection is an effective treatment for appendicitis. Modern medical technology has developed rapidly, but the diagnosis of appendicitis is still based on the theory proposed by Dr. McBurney 100 years ago, and its diagnosis is still highly dependent on symptoms and physical examination. The typical clinical manifestation of acute appendicitis is a gradual onset of vague pain in the upper abdomen or around the umbilicus, with the pain shifting to the right lower abdomen after a few hours. The examination is dominated by pressure pain in the right lower abdomen in the outer third of the line between the umbilicus and the anterior superior iliac spine. This phenomenon was first described by Dr. McBurney, so this pressure point is called “McBurney’s point”. Zhu Genfei, Department of General Surgery, Xiaoshan Hospital, Zhejiang, China The appendix rotates and descends in the abdominal cavity during embryonic development to reach its final position in the right lower abdomen. Therefore, each person’s appendix position is different, and the symptoms and examination will be different. In a few cases, the appendix is located in the pelvis in a low position and the pain is located low near the midline, and the symptoms even start with diarrhea and testicular pain, which is more difficult to determine clinically. Even when the appendix is in a normal high or low position, the symptoms are very different. Since the appendix is only attached to the cecum at the root, it is relatively fixed, while the position of the cephalic end is not fixed and can be both anterior and posterior. For some patients with a posterior appendix, the pain of appendicitis is not obvious, sometimes there is back pain, and if the ureter is affected, there is also hematuria. This wide variation in location not only makes diagnosis difficult, but also makes surgery difficult. Since the right ureter and ovary are anatomically located close to the appendix, ureteral stones on the right side, gynecological diseases on the right side (ovarian cyst torsion, adnexitis, follicular rupture, ectopic pregnancy, etc.) can also have symptoms similar to those of appendicitis, which are sometimes difficult to distinguish from appendicitis. In addition, a series of internal diseases such as mesenteric lymphadenitis, ulcerative colitis, allergic purpura, and enteric typhoid fever may also have symptoms similar to appendicitis and need to be differentiated from appendicitis. As you can see, the appendix may be small, but it is not easy to diagnose. In addition to detailed history analysis, the mainstream laparoscopic surgery is now a good aid. Especially in the diagnosis and treatment of acute abdominal disease, laparoscopy can be used to explore the entire abdominal cavity to determine if the cause of the acute abdominal disease is appendicitis. The laparoscopic exploration extends from the liver to the pelvis, and if it were replaced by open surgery, what a long incision it would take! Therefore, no matter where the lesion is, it can be seen clearly laparoscopically and misdiagnosis and misdiagnosis can be avoided. Advantages of laparoscopic appendicitis 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 accurately grasp the situation in the abdominal cavity by the naked eye due to the incision. Laparoscopic appendectomy is usually performed under general anesthesia with three small holes in the belly, and the surgeon relies on special instruments to perform the appendectomy inside the abdominal cavity. The laparoscope has a high-definition camera system that allows for the observation and diagnosis of all corners of the abdominal cavity. The advantages of laparoscopic appendectomy are not simply in the incision: 1) A large part of the pain after open appendectomy stems from the incision. Because of the incision made during appendicitis, the superficial area is cut with a scalpel and the deep abdominal wall muscle tissue is bluntly pulled away, as is required by the surgical specifications. The blunt trauma is much greater than the sharp, so the postoperative period is painful. Laparoscopic surgery is a perforated hole, and almost no one complains of incisional 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 when they get out of bed the next day. 2) Open surgery is limited by the incision, and it is usually clearly written in textbooks that appendectomy cannot be performed with abdominal irrigation at the end, because the saline used for irrigation will probably not be completely aspirated, which will cause the spread of inflammation. Therefore, the inflammatory exudate caused by appendicitis after open surgery 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, adequate flushing can be performed, and there is absolutely no need to worry about the residual flushing fluid caused by the visual field problem. (3) Incisional infection after open appendectomy is an all-too-common “complication”, especially in patients who are obese or have combined diabetes. In some cases, the infection may persist for a long time. The reason for this is that the appendectomy incision should not be too large and it is not easy to explain to the patient if it is too large. As a result, contamination of the incision is inevitable as the surgeon’s hands or instruments go in and out of the abdominal cavity. In laparoscopic surgery, the surgeon’s hand is outside the patient’s abdominal cavity, and only the instruments enter the abdominal cavity through the puncture sheath, so that the puncture hole is well protected. After laparoscopic appendectomy, there are few incisional infections. Even if there is infection, the degree of infection is much less than that of open surgery, and recovery is much easier. (4) After open appendectomy, there is usually a hard knot at the incision site and an obvious incision scar; after laparoscopic surgery, the incision scar is much lighter, plus the site is hidden and can not even be seen. Therefore, it is very popular among young women. (5) Patients with laparoscopic appendectomy are routinely discharged three days after surgery, while patients with open appendectomy are rarely discharged three days after surgery. (6) Economically speaking, the total cost of laparoscopic appendectomy is not more than that of open surgery because of the short hospital stay, less postoperative medication and fewer postoperative complications.