Single Hole Surgery - Scarless Surgery
You thought that a Surgery, even keyhole,
always produces a scar. Not any
What is the Appendix?
appendix, also known as Vermiform Appendix, is a small
blind ending tubular
structure connected to caecum (starting part of large
intestine). The appendix is located near the junction of
The location of appendix is in the right side of the lower
part of the tummy (abdomen).
Its position within the
abdomen corresponds to a point on the surface known as
McBurney's point (lower one third junction of
line that connects the left hipbone and the belly).
The appendix is
usually about 10 cms in length (ranging from 3-17 cms) and
has diameter of 7-8 mms. It
has no known purpose.
What is Appendicitis?
appendix gets blocked, it can get inflamed. This is called
appendicitis. If the appendix bursts and spreads infection
inside the body, it can be a serious problem. In this
case, one needs to go to a hospital urgently. Symptoms may
include abdominal pain, fever, and vomiting. Most people
who get appendicitis are young, but it can happen to
anyone. One may not even know it until the pain becomes
What are the symptoms of Appendicitis?
main, and in most cases, the only
of appendicitis is strong abdominal pain. Beside pain,
nausea and vomiting accompanied with fever and reduced
appetite can also occur in appendicitis. In the beginning,
it is very difficult to localize the pain and tell from
where it is coming because the appendix is localized deep
in the abdomen. Most of the patients describe radiating
pain in the central
part of their abdomen. However, when inflammation
increases and spreads to peritoneum, a thin membrane that
covers the intestines, pain is localized clearly to one
small area in the lower left part of the abdominal wall.
The exact point is localized on McBurney’s point.
How common is appendicitis?
Appendicitis develops in about 0.25% or of population or 1
in every 400 persons will most likely develop
appendicitis. In India, about 2.6 million (26 lacs) people
develop appendicitis annually.
What is a common man’s risk of developing appendicitis
during his/her lifetime?
overall risk of developing appendicitis during one’s life
is approximately 7%.
How is Appendicitis diagnosed?
diagnosis of acute appendicitis is usually made on the
basis of a patient's clinical history in conjunction with
physical examination and laboratory studies. In patients
who present with typical findings, the aim is to operate
early before any complication
rupture of the appendix) develops. However, in patients
with atypical symptoms, which can occur in infants, small
children, elderly, and young women, radiological studies
could be helpful. Ultrasound and CT scan (contrast
enhanced thin section) can be quite accurate to diagnose
acute Appendicitis (Ultrasound has approximately 90% & CT
scan has upto 95-98% diagnostic accuracy for acute
What is the treatment of Appendicitis?
inflamed appendix generally needs to be removed with
surgery. This is called an appendectomy. When possible,
this is done before it bursts. If the appendix isn’t
removed in time, the infection can cause death. That’s why
the surgery is usually done as an emergency.
How is the Appendix removed?
procedure is normally performed as an emergency procedure
when the patient is suffering from acute appendicitis,
which involves strong pain and fever. All the diagnostic
test should be done very quickly because the time interval
between onset of symptoms and rupture can vary, but in
general-appears to be about 36 to 48 hours. There are two
types of this operation
Single Hole (Scarless) Laparoscopic Surgery
Antibiotics are usually given to the patient prior to
surgery and as soon as appendicitis is suspected. The
child that has serious symptoms should receive intravenous
fluids, antibiotics, and medication for pain relief. The
surgery is done using spinal or general anesthesia.
surgery is performed through a small incision made in the
right lower quadrant of the abdomen. The incision (cut) is
usually two to three inches in length. After examining
the site of inflammation, the appendix is removed. If an
is formed, then the whole collection of pus is being
removed and a small tube may be left in to help drain out
fluids or pus.
laparoscopic operation can be performed through three or
four holes (ports) through which an endoscopic (tubular)
camera and thin long instruments are inserted. The holes
are typically made below the belly button, the left lower
abdomen and the right mid-abdomen. The appendix is
surgically cut from the caecum and removed from one of
these ports. This method has many advantages such as
smaller scar and ability to completely see the other
structures inside the abdomen. The costs of the
laparoscopic operation are slightly greater with than with
an open operation but the hospital stay is much shorter.
Can Appendicitis operation be done through a Single Hole
(Scarless or SILS- single incision laparoscopic surgery)
the appendicitis operation can be done via Scarless
How is Single Hole (Scarless) surgery done?
In SILS, the complete
surgery is done through a single small
1.5 to 2.5 cms. This small cut is made inside the navel
(umbilicus) in such a way that the scar is practically
invisible after the operation, making it a scarless
What are the advantages of Scarless operation for
The scarless surgery is
done through a single small cut. It has numerous
1. Less pain
2. Early discharge from
3. Early return to work
4. Less risk of wound
5. Lesser risk of
hernia formation as no muscle is cut
6. Excellent cosmetic
result as the operation is virtually scarless.
to completely see the other structures inside the abdomen
and rule out or identify other causes of pain, in case the
appendix is found to be normal.
What is Recurrent (or Chronic) Appendicitis?
At times, the
inflammation (swelling) in appendix reduces just by
conservative methods (intravenous fluids, antibiotics,
fasting & hospitalization). After the resolution of
symptoms especially pain, these patients are discharged
from the hospital without the need of surgery. However,
many of these persons keep on developing recurrent
episodes of pain in the right lower tummy similar to the
first appendicitis episode, though a bit milder in
intensity. This condition is called recurrent
appendicitis. The treatment for this condition is Surgical
removal of appendix (known as Interval Appendicectomy),
preferably by laparoscopic (keyhole) method.