Laparoscopic Appendectomy Lecture by Dr. R.K. Mishra

Introduction: Laparoscopic appendectomy is a minimally invasive surgical procedure for the removal of the appendix, typically performed to treat acute appendicitis. This approach has gained popularity due to its advantages over open appendectomy, such as reduced postoperative pain, shorter hospital stay, and faster recovery.

Indications: The primary indication for laparoscopic appendectomy is acute appendicitis. It may also be performed for suspected appendicitis, chronic appendicitis, and incidental appendectomy during other laparoscopic procedures.

Contraindications: Absolute contraindications include hemodynamic instability, uncontrolled coagulopathy, and severe abdominal wall infection. Relative contraindications include morbid obesity, extensive abdominal adhesions, and previous lower abdominal surgeries.

Preoperative preparation: Preoperative evaluation includes a thorough medical history, physical examination, and laboratory testing, such as complete blood count and C-reactive protein. Imaging studies, like abdominal ultrasound or computed tomography (CT), can help confirm the diagnosis. Patients should receive intravenous antibiotics preoperatively and be advised to stop medications that increase the risk of bleeding, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

Surgical technique:

1. Anesthesia: General anesthesia is administered, and the patient is placed in a supine position with the legs apart or together, depending on the surgeon's preference.
2. Pneumoperitoneum: The abdomen is insufflated with carbon dioxide gas to create a working space for the laparoscopic instruments. This is typically achieved using a Veress needle or an open (Hasson) technique.
3. Trocar placement: Usually, three trocars are inserted: a 10-12 mm umbilical trocar for the laparoscope and two 5 mm trocars in the left lower and suprapubic regions for the working instruments.
4. Mobilization: The surgeon identifies the appendix and carefully mobilizes it by dividing any adhesions or the mesoappendix using an electrocautery device, ultrasonic scalpel, or ligasure.
5. Division and removal: The base of the appendix is doubly ligated with endoloops or clipped, and the appendix is then divided between the ligatures or clips. The appendix is removed through one of the trocar sites in a retrieval bag.
6. Inspection and irrigation: The surgeon inspects the abdominal cavity for any signs of infection, perforation, or abscess. If necessary, the peritoneal cavity is irrigated with saline solution and suctioned to remove any residual infection.
7. Closure: The trocar sites are inspected for bleeding or leakage, and the pneumoperitoneum is evacuated. The fascial incision at the umbilical port is closed with sutures, and the skin incisions are closed using sutures, staples, or adhesive strips.

Postoperative care and complications: Patients are usually discharged within 24-48 hours after surgery. They are advised to gradually resume their normal diet and activities. Possible complications include intra-abdominal abscess, wound infection, bowel injury, bleeding, and postoperative ileus. Most complications can be managed conservatively, but some may require additional intervention or conversion to open surgery.

In conclusion, laparoscopic appendectomy is a safe and effective treatment for acute appendicitis, offering numerous advantages over open surgery. With proper preoperative preparation, careful surgical technique, and attentive postoperative care, patients can expect a quick recovery and return to their daily activities with minimal discomfort.