Laparoscopic Lap Appendectomy: Minimal Invasion for Appendicitis

Laparoscopic appendectomy is a surgery to remove the appendix, a finger-shaped organ found in the lower right side of the belly. The surgery is usually done for appendicitis, where the appendix becomes swollen, infected, and painful.

The laparoscopic approach is a safe and efficient operative procedure in appendectomy

It provides clinically beneficial advantages over the open method

including shorter hospital stay,

decreased need for postoperative analgesia,

early food tolerance,

earlier return to work,

lower rate of wound infection

Symptoms of appendicitis often occur suddenly and worsen over time. You might need a laparoscopic appendectomy if you have the following symptoms of appendicitis

1. Severe abdominal (belly) pain in the lower right abdomen, where your appendix is located
2. Whenever you sneeze, cough, inhale or move, the abdominal pain or tenderness worsens
3. Your belly is swollen
4. You have constipation or diarrhoea
5. Bloating or flatulence (unable to pass gas)
6. Low-grade fever (below 100 degrees F)
7. Appetite loss (not feeling hungry as often as you usually would)
8. Nausea and vomiting
9. Appendectomy should be done because there is a risk of sepsis (a life-threatening complication of an infection) due to rupture of the appendix.

The following outcomes can be expected if surgery is delayed:

• You must have your appendix removed if you have appendicitis. Your appendix can burst if left untreated. Therefore, you should seek medical attention immediately. 
• The appendix can burst within 48 to 72 hours after you have symptoms. Your belly can get infected, causing a severe, life-threatening infection called peritonitis (inflammation of the abdominal wall lining).
• Most often, when the surgery is delayed, an appendicular lump can be formed. The standard treatment for an appendicular lump is a conservative treatment followed by an interval or delayed appendectomy.

Laparoscopic appendectomy: 

1. During the surgery, the following steps will be taken:
2. You will be administered general anaesthesia for the surgery. Therefore, you will be completely asleep and unaware during the surgery.
3. You will then be draped (covered with an uncontaminated cloth) to eliminate the passage of microorganisms between the non-sterile and sterile areas.
4. The surgeon will create a small (keyhole) incision (cut) of about one to one and a half cm near your belly button. 
5. A special tool called a port will be inserted through the incision. Appendectomy is traditionally performed laparoscopically through three ports. However, recent studies have reported the use of fewer ports.
6. Carbon dioxide will be pumped through this port to inflate your abdomen so that the surgeon can see the organs in your abdomen.
7. The surgeon will then insert a camera called a laparoscope through the port to view the appendix.
8. Other instruments will be inserted and positioned accordingly to remove the appendix.
9. The surgeon will remove the appendix through one of the incisions and clean the abdomen using sterile fluids to remove any remaining infectious material (if the appendix has burst).
10. The surgeon will remove the air from the abdomen after the area has been cleaned.
11. The incisions will then be closed with sutures (stitches) or bandages. It is not necessary to remove these sutures since they will dissolve on their own.

What to Expect After Surgery?

At hospital: 

1. If your appendix was ruptured before surgery, or you were given general anaesthesia, and have difficulties like severe nausea and vomiting, or are unable to pass urine, you may be admitted to the hospital for the night. 
2. If a child has this surgery, they might feel confused, have stomach sickness or vomit. The reactions will subside once the anaesthesia wears off.
3. There may be a thin plastic tube that goes through your nose into your stomach. The tube is used to remove stomach fluids and air that you swallow. Once your bowels are functioning normally, the tube will be removed. However, until the tube is removed, you won’t be able to eat or drink.
4. The surgeon will ask you to get out of bed a few hours after the surgery.

At home: 

1. Diet:
2. Eat a low-fat, bland diet. This can include foods such as:
3. Plain crackers
4. Plain pasta
5. Cottage cheese
6. Well-cooked soft cereals
7. Low-fat yoghurt
8. Low-fat milk
9. Mashed potatoes
10. Plain toast or bread
11. Rice
12. Ripe bananas
13. If not directed otherwise, drink six to eight glasses of water a day. Take a fibre laxative or stool softener if you are constipated.[10]
14. Wound care (dressing):
15. Incisions must be kept clean and dry. 
16. Your surgeon will explain the care to be taken during bathing. 
17. If adhesive strips are used for incisions, they should be kept dry. They usually fall off in a few days. 
18. Medicines:
19. The incisions and abdominal muscles may hurt, especially after prolonged standing. Take pain relief medicine as recommended by your surgeon.
20. Aspirin or other pain medicines may increase the bleeding risk. Only take medicines that your surgeon has approved.[5]
21. Work, activity, restrictions:
22. Your surgeon will likely encourage you to walk and move around a little. However, avoid strenuous activities. 
23. Make sure you get enough rest. An unhealthy diet and fast lifestyle will hinder your recovery.
24. You should avoid lifting heavy objects and climbing stairs to prevent straining your abdominal muscles.
25. Slowly return to your normal activities after a few days. Include gentle exercise in your daily routine.
26. Swimming may be resumed one to two weeks after surgery.

First Follow up Appointment

1. You must remember the following:
2. Your hospital will schedule a follow-up appointment for you. This usually happens two to three weeks after surgery.
3. A follow-up visit is required to remove any surgical staples or stitches placed.