Laparoscopic appendicectomy has several advantages over the traditional open approach. Special indication is in cases of undiagnosed right iliac fossa pain, in the female patient and the obese. Laparoscopic approach should be adopted as the standard approach over open for appendicectomy.

1. The Case for
LAPAROSCOPIC
APPENDICECTOMY
2018
Dr. Mohamad Al-Gailani FRCS
Consultant Surgeon
Al Hammadi Hospital, Suwaidi
Riyadh, KSA
THE CASE FOR
LAPAROSCOPIC
APPENDICECTOMY
2018
Dr. Mohamad Al-Gailani FRCS
Consultant Surgeon
Al Hammadi Hospital, Suwaidi
Riyadh, KSA

2. ACUTE
APPENDICITIS
 One of the most common causes of the Acute
Abdomen
 One of the most frequent indications for
emergency abdominal surgical procedure
worldwide
 Occurs most frequently in the second and third
decades of life
 The incidence is approximately 233/100,000
population and is highest in the 10 to 19-year-old
age group
 Male to Female ratio 1.4:1
 Lifetime incidence 8.6 %
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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3. Advantagesof
theLaparoscopic
Approach1
A lower rate of wound infections
(Odds Ratio [OR] 0.43, 95% CI
0.34-0.54)
Less pain on postoperative day 1 by
the VAS pain score (8 mm, CI 5-11
mm)
Shorter duration for return of
bowel function
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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4. Advantagesof
the Laparoscopic
Approach2
Shorter duration of Hospital Stay
(1.1 days, CI 0.7-1.5 days)
Fewer Complications (13 % v 22 %)
Less chance of Incisional Hernia
Lower Mortality Rate (0.4 % v 2.1
%)
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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5. SpecialIndications
forthe
Laparoscopic
Approach
1. An Uncertain Diagnosis since it permits
inspection of the whole peritoneal cavity
2. Women of Childbearing Age in whom
laparoscopy may reveal other causes of
pelvic pathology
3. Obese patients since exposure of the right
lower quadrant during open appendectomy
may require larger morbidity-prone
incisions
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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6. 1.
AnUncertain
Diagnosis
 Initial Laparoscopy through a small
incision permits inspection of the whole
peritoneal cavity and is good as a general
laparotomy without the big incision!
 The appendix, pelvic organs, gall bladder
and the presence or absence of pus or free
fluid may be visualized.
 Any need to proceed to open laparotomy
could be planned then through an
appropriate incision.
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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7. 2.
WomenofChild
BearingAge
Improved visualization of the
entire abdomen
Improves the diagnostic accuracy
and can identify the definitive
pathology more often than the open
approach
Potential less adhesions and so less
chance of potential future fertility
concerns
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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8. 3.
Obesity
 Laparoscopic Appendectomy is safe and
effective in obese patients and may be
the preferred approach
 The Laparoscopic approach may convey
some advantages over the open approach
in access to the appendix, visualization,
and decrease in wound complications.
 In the morbidly obese longer trocars and
instruments may be needed.
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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9. Disadvantagesof
theLaparoscopic
Approach
A learning curve is
required
Potential injury during
port insertion
Higher costs of equipment
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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10. Complicationsof
Appendicectomy
inGeneral
Average morbidity near 10%
Adynamic Ileus secondary to
severe sepsis
Surgical Site Infection (SSI)
Dehiscence (open)
Incisional hernia
Pelvic or abdominal abscess
Caecal fistulas
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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11. Removean
Apparently
NormalAppendix
atLaparoscopy?
Should you remove a
macroscopically apparently
Normal Appendix at
Laparoscopy?
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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12. Removean
Apparently
NormalAppendix
atLaparoscopy?
YES
 Macroscopically normal appendixes may have
abnormal histopathology
 19% - 40% rate of pathologically abnormal
appendix in the setting of no visual abnormalities
 The risk of leaving a potentially abnormal
appendix must be weighed against the risk of
appendicectomy in each individual scenario
 Cases of postoperative symptoms requiring
reoperation for appendicectomy have been
described in patients whose normal appendix was
left in place at the time of the original procedure.
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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13. NeedforInterval
(Elective)
Appendectomy?
1
Following successful treatment
of an appendicular mass,
should you plan later for an
Interval or Elective
Appendicectomy?
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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14.  To prevent recurrence of appendicitis
 To exclude neoplasms (such as carcinoid,
adenocarcinoma, mucinous cystadenoma, and
cystadenocarcinomas) especially in older adults
who have higher incidences of appendiceal
neoplasm
 Older patients should also have a colonoscopy or
barium enema to rule out caecal pathology
 The need for interval appendectomy is debated
with some studies suggesting that interval
appendectomy is unnecessary?
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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Need for Interval
(Elective)
Appendectomy?
2

15. NeedforInterval
(Elective)
Appendectomy?
YES!
 Retrospective review of 1012 patients treated non-
operatively for acute appendicitis
 864 patients did not undergo an interval appendectomy
 Of those (4.5 percent) required an appendectomy at a
median follow-up of four years
 A malignant disease was detected in 1.2 %
 Recurrent Appendicitis developed in 7.4 %
 Interval Appendectomy for most adult patients is
Recommended
 Colonoscopy should be considered prior to
Appendectomy in patients over 50 who have not had a
recent colonoscopy
*UptoDate
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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16. SUMMARY
 Diagnostic ability of laparoscopy especially in
female patients
 Decreased postoperative pain
 Earlier discharge
 A shorter time to return to usual activities
 Lower incidence of wound infections or
dehiscence
 Training opportunity for laparoscopic skills
 Better aesthetic result
 Disadvantages: cost!
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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17. CONCLUSION
1. Laparoscopic Appendectomy
Should be the Standard Approach
for patients with Appendicitis or
Suspected Appendicitis.
2. Consider removing a
Macroscopically Normal
Appendix
3. Consider Interval
Appendicectomy for most adult
patients
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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18. REFERENCES
UptoDate
Society of American
Gastrointestinal and
Endoscopic Surgeons (SAGES)
The Case For Laparoscopic Appendicectomy 2018 DR. Mohamad Al-Gailani FRCS Al Hammadi Hospital, Suwaidi, Riyadh, KSA
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