Appendicitis is difficult to diagnose Appendicitis is a common surgical disease, most common in young people, more males than females, clinically acute appendicitis is more common, the incidence rate is about one in a thousand, surgical resection is an effective means of treatment of appendicitis. Modern medical technology is developing rapidly, but the diagnosis of appendicitis is still based on the theory put forward 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 epigastrium or around the umbilicus, with the pain shifting to the right lower abdomen after a few hours. The examination is characterized by pressure pain in the right lower abdomen in the middle and outer third of the line between the umbilicus and the anterior superior iliac spine. This phenomenon was first described by Dr. McBurney, hence the name “McBurney’s point”. During embryonic development, the appendix rotates and descends in the abdominal cavity to its final position in the lower right abdomen. Therefore, the position of the appendix varies from person to person, and the symptoms and examination may be different. A few appendixes with low position are located in the pelvis, the pain is located low near the midline, and the symptoms even start with diarrhea and testicular pain, which are more difficult to determine clinically. Even when the appendix is in a normal high or low position, symptoms vary widely. Since the appendix is only connected to the cecum at the root, it is relatively fixed, while the position of the head end is not fixed and can be either anterior or 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 hematuria. This wide variation in position makes not only diagnosis but also surgery difficult. Since the right ureter and ovary are anatomically close to the appendix, right-sided ureteral stones and right-sided gynecological disorders (ovarian cyst torsion, adnexitis, ruptured follicle, ectopic pregnancy, etc.) can also have symptoms similar to those of appendicitis, which are sometimes difficult to differentiate from appendicitis. In addition, a series of internal diseases, such as mesenteric lymphadenitis, ulcerative colitis, purpura, enteric typhus, etc., also have symptoms similar to appendicitis, which also need to be distinguished from appendicitis. As you can see, although the appendix is small, it is not easy to diagnose. What to do, laparoscopy to help In addition to a detailed analysis of the medical history, now the mainstream laparoscopic surgery is also a very good auxiliary means. Especially in the diagnosis and treatment of acute abdomen, the choice of laparoscopy can be carried out to explore the whole abdominal cavity, to accurately determine whether the cause of acute abdomen is appendicitis. Laparoscopic exploration ranges from the liver down to the pelvis, if it were an open surgery, how long the incision would have to be! Therefore, no matter where the lesion, laparoscopy can see very clearly, can avoid misdiagnosis and mis-treatment. Advantages of laparoscopic appendicitis Traditional surgery: generally with epidural anesthesia, in the right lower abdomen above the appendix to cut an incision of about 3cm or so into the abdominal cavity directly carry out the appendix to be removed, due to the limitations of the incision is very difficult to rely on the naked eye to accurately grasp the situation in the abdominal cavity. Laparoscopic appendectomy generally use general anesthesia, to make three small holes in the belly, the doctor relies on special instruments in the abdominal cavity to complete the appendectomy. Laparoscopy has a high-definition camera system that allows observation and diagnosis of all corners of the abdominal cavity. The advantages of laparoscopic appendectomy do not lie solely in the incision: (1) Much of the pain after open appendectomy stems from the incision. Because the incision is made in appendicitis, the superficial area is cut with a scalpel, and the deeper abdominal wall musculature is bluntly pulled apart, as is required by surgical specifications. Blunt trauma is much greater than sharp, so it’s very painful postoperatively. Laparoscopic surgery is a puncture hole, and almost no one in the patient complains of incisional pain postoperatively. 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 abdominal irrigation cannot be performed at the end of appendectomy because the saline used for irrigation is likely to be unable to be completely suctioned out, which will cause the spread of inflammation. Therefore, the inflammatory exudate caused by appendicitis after open laparotomy 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 appendicectomy. During laparoscopic surgery, adequate irrigation can be carried out, and there is no need to worry about the residual irrigation fluid caused by visual field problems. (3) Incision infection after open appendectomy is a very common “complication”, especially in obese or diabetic patients. In some cases, it may persist for a long time. The reason for this is that the incision of the appendix should not be too large, and if it is too large, it is not easy to explain to the patient. In this way, the doctor’s hands or instruments out of the abdominal cavity, the incision of contamination is inevitable. In laparoscopic surgery, the surgeon’s hand is outside the patient’s abdominal cavity, and only the instruments are inserted into the abdominal cavity through the puncture sheath, so the puncture hole is well protected. After laparoscopic appendectomy, few incisions become infected. Even if infection occurs, the degree of infection is far 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 incisional scar; after laparoscopic surgery, the incisional scar is much milder, plus the site is hidden, and can not even be seen. Therefore, it is popular among young women. (5) Laparoscopic appendectomy patients are routinely discharged three days after surgery, while open appendectomy patients are rarely discharged three days after surgery. (6) Laparoscopic appendectomy may not be cheap financially, but it is worthwhile because of the short hospital stay, fewer post-operative medications, fewer post-operative complications, and the comfort of the entire procedure, which costs around$10,000 to$15,000 in total.