الفهرس 
The Caecum and Vermiform AppendixOnly 14 pages are availabe for public view
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Abstract
The use of laparoscopy enables the surgery to visualize the abdominal cavity to determine the differential diagnosis of the acute abdomen as to diagnose the acute appendicitis, moreover it has been showed that leaving an appendix that appears normal is safe also the number of unnecessary appendicectomies will decrease, especially in fertile women.
Since the advent of laparoscopic surgery, LA has challenged OA as the preferred surgical treatment for acute appendicitis.
As time and experience has progressed it has been used to treat even more complex cases of acute appnedicits to include perforation, abscess and gangrene.
LA has demonstrated superiority over OA in many areas patients who underwent successful LA have a better postoperative recovery due to the reduced trauma to the abdominal wall also the better mobility of the abdominal musculature and the earlier ambulation, reduce the risk of the early postoperative complications of pneumonia and embolism.
Thus the time to return to normal activity as work, sports is significantly shorter than that following open appendicectomy the laparoscopic surgical techniques lead to fewer intra-abdominal adhesions by reducing tissue trauma, which in turn reduces circulating inflammatory medicators, thus LA in young females is important to reduce postoperative adhesions that lead to occurrence of infertility.
LA has been shown to have fewer postoperative complications as surgical site infection which was more common in the open OA with no surgical site infection in the LA. Another complication as ileus was noted in the OA more increase than in the LA.
Also the complication rate of resident doing LA was still lower than OA the complication rate went down with increasing experience of the laparoscopist. There is a group of laparoscopic surgeons are now gaining confidence in handling complicated cases of appendicitis, also there is a large group of surgeons who believe that LA is safe in all forms of appendicitis, even in perforated appendicitis.
The prolonged hospital stay and risk leave noted in overweight patients undergoing open appendicectomy which was abolished when overweight patients were treated with laparoscopic appendicectomy laparoscopic procedure is beneficial in obese females and those presenting with appendiceal abscess which are treated by intravenous antibiotics and percutaneous drainage followed by interval appendicectomy according to the opinion of some surgeons.
The increasing interest in using laparoscopic procedures during pregnancy is noted in several studies that showed LA is safe in all trimesters of pregnancy also some surgeons are suggesting to postpone operative intervention until the second trimester when foetal risk is lowest.
During laparoscopic surgery the cell mediated immunity is less impaired including reduction in the number of circulating lymphocytes, impairment of natural killer cell cytotoxicity, depression of T cell proliferation and diminished neutrophil function this occurs less than after open surgery.
LA has clear benefit over open in patients with sickle cell disease than open procedure in decreasing the risks of high morbidity and mortality as a result of peri-operative and postoperative complication mainly vaso-occlusive crises.
The immunity of the cirrhotic patient is compromised and there is more chance of wound infection with the open surgical procedure thus patients with cirrhosis have shown a faster recovery when treated by laparoscopic procedure.
It is proved that LA causes less post-operative pain than OA as multiple small incisions as compared to one large muscle splitting incision leads to decreased post operative pain.
Diclefenac was the analysis used in the patients.
The LA group required fewer (3.31 IV doses and 2.85 oral doses) compared to the OA group (7.05 IV doses and 4.53 and doses).
Most surgeons have the opinion that LA is cost effective it may be more expensive for the hospital but it offers diagnostic accuracy and among employed patients offers cost savings to society as a result of faster return to work, sports.
The surgical experience of trained specialized laparoscopic surgeons can reduce the complications such as intra-abdominal abscess following LA for perforated appendices.
The strength of LA led have led to the application of single incision laparoscopic surgery to the treatment of acute appendicits.
Despite its promising future. SILS appendicectomy (SA) cannot match the superiority of LA for treatment of acute appendicits at this time. LA should be considered the preferred method of apendicectomy.
The future prospects of LA remote handling technology will overcome some of the manipulative restriction of current instruments. There is no doubt that 20 years from non some surgeons will be operating exclusively via a computer interface controlling a master-slave manipulator. But the future of any new technology depends up on applications and training.