Laparoscopic Appendectomy for Appendicitis in India

Common Symptoms of Appendicitis

The symptoms of appendicitis begin around the navel area and then shift to the lower right side of the abdomen within 6-12 hours. This pain pattern helps distinguish appendicitis from other abdominal conditions. The pain often worsens over 12-18 hours and becomes more intense with movement, coughing, or sneezing. Additional symptoms usually develop as the inflammation progresses:

• Abdominal pain in the lower right side
• Nausea and vomiting
• Fever
• Appetite loss
• Constipation or diarrhoea

How Appendicitis is Diagnosed

It can be difficult to diagnose appendicitis because its symptoms often resemble those of other conditions, such as kidney stones, gallbladder disease, or gastroenteritis. Physicians in the emergency department follow a systematic approach combining clinical assessment with diagnostic imaging to reduce the risk of misdiagnosis. Timely and correct diagnosis is essential to prevent complications like rupture, which happens in most cases when treatment is delayed for more than 24 hours.

Appendicitis diagnostic methods include:

• Physical examination: Doctors check for abdominal tenderness, particularly at McBurney’s point in the lower right abdomen
• Blood tests: Complete blood count measures white blood cell levels to detect infection and inflammation markers
• Ultrasound imaging: Non-invasive scan that can visualize appendix swelling and detect fluid collection around the organ
• CT scan: Provides detailed cross-sectional images to confirm appendicitis and rule out other abdominal conditions
• MRI scanning: Used primarily in pregnant women or when CT scan results are inconclusive

When is Laparoscopic Appendectomy Needed?

Laparoscopic appendectomy is a preferred surgical approach for treating appendicitis in most cases. The decision for surgical intervention depends on the severity of inflammation, patient age, and the complications involved. Doctors recommend surgery within 12-24 hours of diagnosis to prevent appendix rupture and associated complications.

Surgical indications of appendicitis removal include:

• Confirmed acute appendicitis: Imaging studies and clinical findings definitively show appendix inflammation that needs immediate removal
• Antibiotic treatment failure: Cases where initial antibiotic therapy does not resolve symptoms within 24-48 hours
• Complicated appendicitis: Presence of abscess, perforation, or peritonitis requires urgent surgical intervention
• Rupture risk: High probability of appendix rupture based on symptom duration and severity of inflammation

Preoperative Evaluation and Preparation

Patients scheduled for laparoscopic appendectomy undergo a comprehensive preoperative assessment to minimize surgical risks and ensure optimal outcomes. The evaluation process is faster in emergency cases but still maintains safety protocols. Most patients are prepared for surgery within 2-6 hours of hospital admission, depending on the urgency of the case and hospital workflow.

Preparation steps for appendicitis surgery involve:

• Medical history assessment: Comprehensive review of current medications, drug allergies, previous abdominal surgeries, bleeding disorders, and underlying medical conditions that may affect surgical outcomes
• Anaesthesia clearance: Detailed evaluation by an anaesthesiologist, including cardiovascular assessment, airway examination, and pulmonary function tests if indicated by patient age or comorbidities
• Preoperative fasting: Complete restriction of food and liquids for a minimum of 8 hours before surgery to prevent aspiration pneumonia during general anaesthesia induction
• Bowel preparation: Rarely required for routine appendicitis cases, but may be necessary if bowel perforation or extensive contamination is suspected based on imaging findings

Surgical Steps in Laparoscopic Appendectomy

The laparoscopic appendectomy procedure follows standardized surgical protocols established by international surgical societies. Modern operating rooms in India are equipped with high-definition laparoscopic systems that provide surgeons with magnified, clear visualization of internal structures. The procedure typically takes 30-60 minutes and is performed under general anaesthesia in a sterile operating room environment.

The surgical steps taken are:

1. General Anaesthesia Administration: The patient receives intravenous drugs to induce unconsciousness. Inhaled anaesthetic gases maintain this state. Complete muscle relaxation is ensured throughout the procedure.
2. Small Incision Creation: Three or four incisions, each 5–10 mm wide, are made in the abdomen. These are typically located at the umbilicus, left lower quadrant, and suprapubic region. Trocars are inserted through these incisions to access the abdominal cavity.
3. Laparoscope Insertion: A high-definition laparoscope with LED lighting is introduced through the umbilical port. It provides 10–15x magnified visualisation of internal organs. The live feed is displayed on monitor screens for surgical navigation.
4. Appendix Identification and Removal: The appendix is located and separated from surrounding adhesions. The appendiceal artery is identified and sealed using clips or energy devices. The appendix is detached from the cecum using staplers or endoloops.
5. Specimen Retrieval and Closure: The removed appendix is placed in a sterile extraction bag to avoid contamination during removal. The abdominal cavity may be irrigated if required. Incisions are then closed using absorbable sutures, skin adhesive, or surgical staples.

Recovery in Hospital After Appendix Removal Surgery

Hospital recovery after laparoscopic appendectomy is shorter than traditional open surgery. Most patients are discharged within 24-48 hours. Enhanced recovery protocols implemented in Indian hospitals focus on early mobilization, optimal pain control, and rapid return to normal function. Medical staff monitor patients closely during this period to ensure proper healing and detect any early signs of complications.

Post surgery hospital care involves:

• Pain Management: A multimodal analgesia approach is used. This includes oral pain medications and regional nerve blocks. Opioid use is kept minimal. The goal is to control pain while supporting early movement.
• Early Mobilisation: Patients are encouraged to sit up and walk within 4–6 hours after surgery. This is done under nursing supervision. Early movement helps prevent venous thromboembolism and speeds up recovery.
• Diet Progression: Clear liquids are started 2–4 hours after surgery, once bowel sounds return. The diet is gradually advanced to soft solids within 12–24 hours. This depends on how well the gastrointestinal system recovers.
• Discharge Criteria: Patients can be discharged once vital signs are stable. They should tolerate oral pain medications, pass urine normally, and walk without help. These criteria ensure safe recovery at home.

Recovery at Home and Follow-Up

Home recovery from laparoscopic appendectomy varies based on individual healing capacity, age, and adherence to post-operative instructions. Most patients return to desk jobs within a few days, while those with physically demanding occupations may need more time off work. The minimally invasive nature of the procedure allows faster return to normal activities compared to open surgery, with reduced risk of incisional hernias and adhesion formation.

Home care tips after appendectomy include:

• Wound Maintenance: Keep incision sites clean and dry. Use mild soap and water after 48 hours when showering. Avoid soaking in bathtubs or swimming pools for seven to ten days, or as recommended by your doctor. Gently pat the area dry after cleaning.
• Activity Restrictions: Light activities such as walking can start on the first day. Avoid lifting more than five kilograms and intense exercise for two to three weeks. Resume normal tasks gradually based on comfort.
• Complication Warning Signs: Seek medical care for a fever above 101 degrees Fahrenheit or 38.3 degrees Celsius. Watch for severe abdominal pain, ongoing vomiting, or discharge from incision sites. These may indicate complications.
• Follow-Up Scheduling: A follow-up visit is usually scheduled within seven to fourteen days. The doctor checks wound healing and removes any non-absorbable sutures. Patients can raise any concerns about their recovery during this visit.

Estimated Cost of Laparoscopic Appendectomy in India

The cost of a laparoscopic appendectomy in India depends on hospital infrastructure, surgeon expertise, insurance coverage, and geographical location. Government hospitals may offer subsidised rates, while corporate hospitals tend to have higher charges due to advanced facilities and shorter waiting times. Most health insurance policies cover emergency appendicitis surgery.