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Laparoscopic Appendectomy

Dr.S.Navaneethakrishnan MBBS.,MS.,FICS.,FAIS

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Topics

After locating the appendix separate the appendix from the surrounding adhesions and meso appendix was divided with Electrocautery (we always use monopolar cautery) and base of the appendix ligated with pre-tied Roeder’s Endo knot and appendectomy done. It is our routine to walk through the intestine after the appendicectomy to search for Meckel’s diverticulam.

COMPLICATION

  • Conversion to the open procedure should not be regarded as a failure.
  • Similar complication to those encountered after open appendicectomy can be expected after laparoscopic appendectomy
  • Wound infection less
  • Thermal injury due to diathermy.

Advantages of Laparoscopic Approach

  1. It affords a better view of appendix and pelvic organs resulting greater diagnostic accuracy.
  2. In infected cases peritoneal cavity can be more thoroughly irrigated and free fluid and purulent collections aspirated under direct vision.
  3. It requires a small puncture wound rather than the muscle cutting or muscle splitting incision resulting less postoperative pain in Laparoscopic approach.
  4. Intra abdominal adhesions are lower than the open surgery
  5. Infertility problems in female patients are also reduced in Laparoscopic approach because of less Intra abdominal adhesions.

Financial Implication

Need of special instruments for laparoscopic surgery resulting in extra costs. Otherwise less hospitalization and early return to full normal activity is the benefit.

Our Experience of 327 Cases

Total No. Of cases for the past 4 years between 1994 to 1997 were 327. Of which we have operated 118 cases of children below 14 years.

Age: More numbers between 10 – 20 years about 174 cases.

  1. Below 10 Years – 13
  2. 10-14 Years – 105
  3. 14- 20 Years – 69

Sex : Male children are slightly higher than the Female

  • Male – 62 – 52.5 %
  • Female – 56 – 47.5 %

Position: Total No’s. 118

  • Retrocaecal – 57
  • Pelvic – 24
  • Pre-ileal – 20
  • Sub-Caecal – 9
  • Para-Caecal – 8

Classification: We formed the following classification

  • Perforated Appendix – 2 Cases
  • Appendicular Mass – 3 Cases
  • Acute Appendicitis – 59 Cases
  • Chronically Recurring Appendicitis – 31 Cases
  • Chronic Appendicitis – 23 Cases

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