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Anal Fistula, Piles and Fissure are together known as Benign ano-rectal conditions. These conditions are not fatal but they are extremely agonizing..

What further increases the anxiety is the fact that their conventional treatment is even more traumatic and painful resulting in large wounds.

But now procedures are available which have made the treatment of these disorders virtually cut less, woundless and painless.




Single Hole Surgery - Scarless Surgery            

You thought that a Surgery, even keyhole, always produces a scar. Not any more!

Appendix                                                                      Gall Bladder / Uterus / Hernia, click here

What is the Appendix?

The 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 small intestine and the large intestine. 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 the 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?

If the 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 severe.

What are the symptoms of Appendicitis?

The main, and in most cases, the only symptom 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?

Acute 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?

The overall risk of developing appendicitis during one’s life is approximately 7%.

How is Appendicitis diagnosed?

A 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 (especially 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 appendicitis).

What is the treatment of Appendicitis?

 An 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?

This 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

1.          Open Surgery

2.          Laparoscopic Surgery

Now, 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.

Open 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 abscess 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.

The 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) Laparoscopic Surgery?

Yes, the appendicitis operation can be done via Scarless Method.

How is Single Hole (Scarless) surgery done?

In SILS, the complete surgery is done through a single small puncture/hole/incision of about 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 surgery.

What are the advantages of Scarless operation for Appendix?

The scarless surgery is done through a single small cut. It has numerous advantages:-

1. Less pain

2. Early discharge from the hospital

3. Early return to work

4. Less risk of wound infection

5. Lesser risk of hernia formation as no muscle is cut

6. Excellent cosmetic result as the operation is virtually scarless.

7. Ability 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.






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Dr Pankaj