Appendix is a tubular organ attached to the first part of the large intestine called cecum. It lies in the right lower quadrant of the abdomen. The appendix is called a “vestigial” organ as it does not serve any useful function in the body. It can vary in its length from around 3cm to over 10 cm. In the centre of the appendix is a find lumen that is connected with the cecum. Normally, the lumen is only wide enough to admit a matchstick.

Appendix attached to the right colon (caecum)
Appendicitis is infection of the appendix. Usually this happens suddenly and is called acute appendicitis. The appendix commonly gets infected when its lumen is blocked. This causes the portion of the appendix beyond the blockage to get swollen and inflamed. As the appendix gets swollen, the blood vessels carrying blood to it and away from it are likely to get blocked. This causes gangrenous change in the appendix. Often, intestinal loops in the area as well as the omentum (a fatty curtain inside the abdomen) get stuck to an infected appendix in order to contain the infection in one corner of the abdomen. An inflamed appendix may burst inside the abdomen. Rarely, the appendix may get infected off and on and produce pain in the right lower abdomen from time to time.

When the appendix gets acutely inflamed the white cell (WBC) count may be raised. An ultrasound examination may show a thickened appendix with some fluid around it. Sometimes when the diagnosis of appendicitis is not clear the doctor may order a CT scan, which is the most sensitive test for diagnosing acute appendicitis. In patients who have repeated episodes of pain in the right lower side of the abdomen the appendix may or may not be the cause for it.Particularly in women diseases affecting organs like the ovaries or fallopian tubes may produce pain similar to that caused by appendicitis. In these patients laparoscopy provides the best way of assessment.

Ultrasound examination showing thickened appendix

CT scan confirms acute appendicitis

The standard treatment for appendicitis is surgical removal of the appendix. The traditional open surgery requires a cut of around 5 cm – 10 cm for removal of the appendix. There are several disadvantages of an open operation. In obese patients or when a swollen appendix is hidden behind the intestines, the cut may have to be enlarged to reach the appendix. This type of a cut is likely to get infected, particularly if the appendix is badly infected or ruptured with pus in the abdomen. Sometime there are conditions affecting other organs like ovaries, tubes or intestines mimic appendicitis. At surgery if the appendix is found to be normal, the surgeon needs to check these other organs to find out the cause of the pain. Doing this by open surgery often requires enlargement of the cut.

Scar of open appendectomy

Small incisions used for laparoscopic appendectomy

Laparoscopic appendectomy is performed through three cuts – a 1cm cut at the navel and two 5mm cuts in the lower abdomen.
The surgeon passes tubes called “ports” through these small cuts. A telescope is introduced through one of them and two instruments through the other ports.
The appendix is freed up, its junction with the cecum is ligated and it is removed via the port.
As the cuts made for laparoscopic appendectomy are small, the chances of infection in them are reduced. Also, even if the appendix is hidden behind intestines, the surgeon is more often than not able to complete the operation using only three ports. This is true whatever the built of the patient – slim or obese. Also, the surgeon is able to survey all the other organs in the region, if required, in the eventuality that the appendix looks normal and is considered not to be the cause of the pain.

  • Less pain after surgery from the small  incisions
  • Shorter hospital stay
  • Shorter recovery time
  • Faster return to normal diet
  • Faster return to work or normal activity
  • Better cosmetic healing

Publications and abstracts

  1. Bhandarkar DS, Bhagwat S, Punjani RM. Port-site infection with Mycobacterium chelonei following laparoscopic appendicectomy. Indian J Gastroenterol 2001; 20:247-48.
  2. Bhandarkar DS, Shah RS. A novel method of retrieval of the appendix in laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 2002; 12: 117-18.

Book chapters

  1. Bhandarkar DS, Behera RR. Laparoscopic surgery for acute appendicitis. In, The Appendix. ECPB Clinical Update Series. Nundy S, Nagral S (Editors). Elsevier. 2011;45-61.

Presentations, invited lectures & videos

  1. Bhandarkar DS. Laparoscopic appendicectomy. Video Operative Surgery Workshop, Surgical Society Thane, Bhiwandi, 2002.
  2. Bhandarkar DS. Role of laparoscopy in appendicitis. Annual Conference of Association of Colon Rectal Surgeons of India. Mumbai, 2008.
  3. Bhandarkar DS. Laparoscopic appendicectomy. Sixth FIAGES Course, Raipur, 2009.
  4. Bhandarkar DS, Kochar R, Katara AN, Udwadia TE. Laparoscopic appendicectomy for mucinous cystadenoma of the appendix. 54th Annual Conference of International College of Surgeons. Trichy, 2008.

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