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Abstract
Appendicectomy by McBurneys incision remained the procedure of choice for nearly a century until 1983 when Kurt Semm offered an alternative, “laparoscopic appendicectomy” .
But as McBurney’s operation is well tolerated with less co-morbidity the benefits of laparoscopic appendicectomy have been difficult to establish . The putative advantages of the laparoscopic approach are quicker and less painful recovery, fewer postoperative complications and better cosmesis .
It allows better assessment of other intra-abdominal pathologies. But, because the validity of these point’s remains unconvincing and also because of shortage of laparoscopic sets in some hospitals, laparoscopic appendicectomy is not practiced widely . Twenty years later laparoscopic appendicectomy is all set to become the choice of therapeutic modality . A prospective comparative study was done to highlight the advantages of this procedure and proves it to be superior over open appendicectomy .
Despite new x-ray techniques, CT scans and ultrasounds, the diagnosis of appendicitis can be challenging. So far the most accurate non-invasive method of diagnosis is ultrasonography but this is not totally reliable. The history and physical examination will generally lead to the correct diagnosis. According to one prospective non-randomised study laparoscopy may prevent unnecessary appendectomy in 24% of patients. Laparoscopy reveals a misdiagnosis rate of 8% in male, and 41% in female of reproductive age group .
Laparoscopic appendectomy gives a better evaluation of the peritoneal cavity than that obtained by the standard grid-iron exposure. The procedure allows rapid and thorough inspection of the paracolic gutters and the pelvic cavity that is not possible with the open grid-iron approach. The laparoscopic approach for patient with suspected appendicitis improves the diagnostic accuracy and is therefore recommended .
Laparoscopic appendicectomy is better than open appendiectomy with respect to wound infection rate, early resumption of oral feeds, postoperative pain, lesser use of analgesics, postoperative hospital stay and return to normal activities .