Laparoscopy and Laparotomy
The mainstay for management of acute appendicitis is appendicectomy. Apart from clinical judgement, radiological modalities such as ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI) may aid in the diagnosis of appendicitis. Prior optimization of the patient with analgesia, fluid resuscitation and antibiotics are adjuncts for a smooth recovery. Pre-operative antibiotic prophylaxis is generally considered for all cases and a post-operative course of intravenous/oral antibiotics for cases of complicated appendicitis including those presenting with gangrene or perforation. Peri-operative antibiotic guidelines have been set for paediatric patients. Antibiotic treatment alone may be considered in special circumstances where surgery is either contraindicated or not feasible. Traditional open surgery and minimal invasive surgery such as laparoscopic appendicectomy are currently the procedures of choice. Evidence from randomized trials and meta-analyses suggest some benefits of the laparoscopic approach such as decreased length of stay, earlier recovery and return to work and lower incidence of superficial wound infections. Newer treatment modalities such as Single Incision Laparoscopic Surgery (SILS) and Natural orifice transluminal endoscopic surgery (NOTES) are currently being developed.
KeywordsAcute Appendicitis Laparoscopic Appendicectomy Open Appendicectomy Perforated Appendicitis Single Incision Laparoscopic Surgery
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