The appendix is a narrow, small, finger-shaped portion of the large intestine that generally hangs down from the lower right side of the abdomen.
If the appendix becomes infected (appendicitis), the infected appendix must be surgically removed (emergency appendectomy) before a hole develops in the appendix (perforation) and spreads the infection to the entire abdominal space (peritonitis). In some cases of early acute appendicitis, the condition can be treated by antibiotics and supportive measures provided there is no faecolith causing blockage to the lumen of appendix. In some cases non calcified faecolith may not be visualised on pre-treatment CT scan.
Appendicitis is a sudden inflammation of the appendix. Although the appendix does not seem to serve any purpose, it can become diseased and, if untreated, can burst, causing infection and even death.
The cause of appendicitis is usually unknown. Appendicitis may occur after a viral infection in the digestive tract or when the tube connecting the large intestine and appendix is blocked or trapped by stool pellet called faecolith. It is thought that blockage of the opening of the appendix into the bowel by a hard, small stool fragment causes inflammation and infection of the appendix (appendicitis). The inflammation can cause infection, gangrenous change in the wall of appendix due to blockage of appendicular blood vessels. This may lead to rupture of the appendicular wall leading to formation of abscess and or peritonitis. The later conditions can be quite serious and needs urgent attention and surgical treatment.
The infected appendix then must be surgically removed (emergency appendectomy) before a hole develops in the appendix and spreads the infection to the entire abdominal space.
The best treatment of appendicitis is its surgical removal. Mild appendicitis may sometimes be treated with antibiotics. More serious cases are treated with surgery to remove the appendix, called an appendectomy.
Doctors either use an “open” technique or a minimally invasive approach to remove the appendix known as laparoscopic appendicectomy when it is performed through three key holes or small incisions. The most recent advance is performing laparoscopic appendicectomy through 1 key hole.
At my centre I most commonly perform the One Key Hole Laparoscopic Appendicectomy, which is the most recent innovation in the technique of appendicectomy with least amount of wound associated pain and heals without any obviously visible scars.
Appendicitis is considered an emergency and anyone with symptoms needs to see a doctor immediately!
Laparoscopic appendicectomy is the procedure when the surgery is performed through three key holes, with one at the belly button(umbilicus) and of the other two one cut is made in the right lower quadrant of abdomen and one in the suprapubic area.
At my centre I most commonly perform One Key Hole Laparoscopic Appendicectomy, which is the most recent innovation in the technique of appendicectomy with least amount of wound associated pain and heals without any obviously visible scars. I have been doing this surgery since 2009 and have had the privilege of starting this program in Singapore and South East Asia starting with first such surgery in the region.
Most cases of acute appendicitis can be treated by one key hole laparoscopic surgery.
The main advantages are:
In most cases, patients can be discharged within 24 to 48 hours. By contrast, the hospital stay is typically two to five days for an open procedure.
The elderly may also be at increased risk for complications with general anaesthesia. We evaluate every patient to determine the appropriate type of surgery to perform.
In most cases, patients can be discharged within 24 to 48 hours. By contrast, the hospital stay is typically two to five days for an open procedure.
The elderly may also be at increased risk for complications with general anaesthesia. We evaluate every patient to determine the appropriate type of surgery to perform.
The words “laparoscopic” and “open” appendectomy describes the techniques a surgeon uses to gain access to the internal surgery site.
Most laparoscopic appendectomies start the same way. Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through a cannula, giving the surgeon a magnified view of the patient’s internal organs on a television monitor. Several other cannulas are inserted to allow the surgeon to work inside and remove the appendix. The entire procedure may be completed through the cannulas or by lengthening one of the small cannula incisions. A drain may be placed during the procedure. This will be removed before you leave the hospital. In one key hole laparoscopic surgery, the camera and the instruments go through the same small incision within the belly button.
In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. Factors that may increase the possibility of converting to the “open” procedure may include:
Senior Consultant Single Keyhole Laparoscopic Surgeon
MBBS, M.S (Gen Surg – KEMH, Bombay), FAMS
Over 30 years of clinical experience in gastrointestinal and metabolic surgery
Dr. Ravi has been practicing surgery for more than three decades, with extensive experience in Hepato Pancreatico Biliary conditions with advanced laparoscopic surgery inclusive of one key hole laparoscopic surgery and liver transplants
His clinical focus includes:
Dr. Ravi routinely performs laparoscopic (keyhole) and endoscopic procedures, which are associated with smaller incisions and faster recovery times compared to traditional open surgery.
(Based on standard clinical outcomes for minimally invasive techniques.)
He holds a university academic appointment and is actively involved in teaching medical students and surgical trainees in Singapore, reflecting his commitment to medical education and continuous learning.
Dr. Ravi is affiliated with various international and local professional bodies including:
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