Laparoscopic appendectomy

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Risks of laparoscopic appendectomy

Conversion to an open procedure 

It is necessary for surgeons to make a larger incision to complete an appendectomy safely due to a variety of situations. If the appendicitis has perforated, or if infection and inflammation has spread beyond just the appendix, need for conversion to an open procedure may be more likely.  In some situations, the surgeon may recommend an open operation through a larger incision instead of attempting a laparoscopic approach. The surgeon will use his or her best judgment to do what is safest in any particular situation.

Persistent pain following surgery  

Pain and discomfort following surgery for appendicitis is variable, and seems to be related to the degree of inflammation in the area of the appendix.  If the appendix was perforated or associated with significant infection or an abscess, antibiotics will be prescribed for up to 2 weeks. It is common for the area to remain tender until all infection clears and associated inflammation resolves.

Infection  

Infection at the incision sites can be seen more commonly in people undergoing appendectomy who have had symptoms for more than 36 hours. This can usually be treated without additional surgery. More serious infections deeper in the abdomen may require a minimally invasive drain placement with x-ray imaging, or may occasionally require additional surgical procedures to clear the infection.

Incisional hernia  

Hernias develop in less than 1% of people having laparoscopic appendectomy surgery.  Hernias occur when the muscle layer at an incision fails to heal, and are recognizable as a swelling or bulge beneath one of the scars developing weeks to months after surgery. A firm knot or bulge beneath the incision within the first few days after surgery is normal, and is rarely a hernia. Repair of this type of hernia requires a surgical procedure, usually as an outpatient. Risk of incisional hernia may be significantly higher if an larger open incision is required, although typically less than 3-5%.

Bleeding  

Bleeding from the skin incisions is typically minimal, rarely dangerous and often will stop with application of gentle pressure. Bruising may commonly be seen, especially in individuals on aspirin or blood thinners. More serious internal bleeding associated with injury to larger blood vessels is known to occur in less than 0.5% of surgeries. This is typically recognized at the time of surgery and may require conversion to an open procedure.

Injury to other structures 

Injury to the small bowel or colon might occur and risk is higher in individuals who have had prior abdominal or pelvic surgeries, marked inflammation from an appendicitis of more than 1 to 2 days duration, presence of an abscess or peritonitis.  Such injuries are uncommon, occurring in less than 1%. Conversion to an open surgery may be required to repair these injuries. Occasionally, such severe inflammation exists that a segment of the small bowel and colon must be removed to adequately treat the infection caused by the advanced appendicitis.

Swelling or bruising 

Significant bruising and swelling occurs frequently following laparoscopic inguinal hernia repair.  Such bruising and swelling may worsen over a period of 3 to 5 days before gradually returning to normal.  Wearing an athletic supporter or snug underwear might help with any discomfort..

Bowel obstruction  

Any surgical procedure, including inguinal hernia repair, can result in formation of scar or adhesions. Such scarring in the abdomen is associated with a risk of bowel obstruction.  Bowel obstruction is seen very rarely following laparoscopic inguinal hernia repair surgeries, but may occur in up to 6% of individuals who required an open incision for appendix removal.

Death  

Death is uncommonly related to inguinal hernia surgery. Healthy individuals have a less than 1 in 1,000 chance of death. Risk of death increase with other medical problems such as heart disease, COPD, diabetes, obesity and other medical conditions. Age also increases the risk of death associated with gallbladder surgery, but a reasonably healthy individual 70 years of age has a risk of death of only about 2%.