Laparoscopic appendectomy
The appendix is a small finger-size bit of intestine attached to the first part of the colon. It is probably a remnant of a large collection of lymph nodes that were required when the human diet consisted of a large amount of raw meat. Over the millenia it has become unnecessary, but persists as a potentially troublesome structure.
The mouth of the appendix is small, and if a small bit of food (a seed, for example) or other undigested debris happens to block this small opening, the appendix cannot empty itself of the small amount of mucus that it continually produces. The appendix then slowly becomes engorged with mucus, and over a period of 1-3 days can become swollen to the point of rupture. When it ruptures, some of the bacteria in the stool contained within the colon (to which the appendix is attached) can also leak, causing infection.
This is a purely mechanical problem, and the solution is to remove the mechanism of the problem: the appendix itself. The appendix has no significant function, and there are no digestive side effects to its removal.
In the past, a painful incision was required to remove the offending appendix, but today a large number of appendectomies are performed using a camera and instruments placed through very small incisions. This procedure is known as a laparoscopic appendectomy. Two 5 mm holes (1/5 inch) and one 10 mm hole (2/5 inch) are used by Dr. Mazzarella when he removes the appendix.
An average operation lasts 20 minutes, and almost all patients are able to go home the same day. Dr. Mazzarella has performed this operation hundreds of times, including for individuals who were turned down by other surgeons.
The camera is also able to visualize many other structures within the abdomen and can ensure that many other types of problems do not exist.
Lab tests and physical symptoms are important in diagnosing appendicitis. A CT scan is commonly used to diagnose appendicitis, but a CT scan can be inaccurate in up to 15% of cases. During operation, conditions either less severe or more severe than those indicated on the CT scan are often found. The camera, which can visualize a majority of the abdomen, is superior in diagnosing and treating perforated appendicitis, or for determining if other conditions exist that have been confused with appendicitis.
Any infection found can also be washed and cleaned under direct vision using the camera. (Open appendectomies, even though using larger incisions, can only visualize a limited area under the incision and not the entire abdomen).
Furthermore, a laparoscopic appendectomy is performed using long instruments though tiny incisions on the opposite side of the abdomen; the incisions are made away from any infection. Wound infections are therefore almost non-existent with laparoscopy (compared to the 10%-30% risk of wound infection after open appendectomies when an operation is done for perforated appendicitis).
For these reasons Dr. Mazzarella almost never performs open appendectomies any longer (since 2002), except by request. Recovery from laparoscopy is almost immediate, even with perforated appendicitis (compared to a 6 week recovery period for an open appendectomy). Even sports and strenuous activities can be resumed shortly after laparoscopy.
If your physician has determined that you have appendicitis, a laparoscopic appendectomy is the easiest next step in treating the problem.
If you would like to discuss this procedure further with Dr. Mazzarella, call (530) 458-3243. If you would like to have your questions answered first, Telemedicine consults are also available.
More resources and counseling regarding laparoscopic removal of the appendix:
* When you need an operation... About Appendectomy (American College of Surgeons)
* Laparoscopic Appendectomy -- Technique (Online Laparoscopic Technical Manual)