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Tatalaksana Appendisitis
The words “laparoscopic” and “open” appendectomy describes the techniques a surgeon uses to gain
access to the internal surgery site. Most laparoscopic appendectomies start the same way. Using a
cannula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny
telescope connected to a video camera) is inserted through a cannula, giving the surgeon a magnified
view of the patient’s internal organs on a television monitor. Several other cannulas are inserted to
allow the surgeon to work inside and remove the appendix. The entire procedure may be completed
through the cannulas or by lengthening one of the small cannula incisions. A drain may be placed
during the procedure. This will be removed later by your surgeon.
Video
Advantages of Laparoscopic Appendectomy
Results may vary depending upon the type of procedure and patient’s overall condition.

Common advantages are:

 Less postoperative pain

 May shorten hospital stay

 May result in a quicker return to bowel function

 Quicker return to normal activity

 Better cosmetic results

In a small number of patients the laparoscopic method is not feasible because of the inability to
visualize or handle the organs effectively.

Factors that may increase the possibility of converting to the “open” procedure may include:

 Extensive infection and/or abscess

 A perforated appendix

 Obesity

 A history of prior abdominal surgery causing dense scar tissue

 Inability to visualize organs

 Bleeding problems during the operation

Although laparoscopic appendectomy has many benefits, it may not be appropriate for some
patients. Early, non-ruptured appendicitis usually can be removed laparoscopically.
Laparoscopic appendectomy is more difficult to perform if there is advanced infection or the
appendix has ruptured. A traditional, open procedure using a larger incision may be required to
safely remove the infected appendix in these patients.
Tatalaksana
Appendisitis
Tatalaksana
Appendisitis

Pemberian antibiotik
NOM (Non-Operative Management)

Catatan:
Penundaan tindak bedah sambil memberikan
antibiotik dapat mengakibatkan abses atau
perforasi.
Approximately 90% of patients treated with antibiotics are able to avoid surgery during the initial admission.

The other 10% that fail to respond to antibiotics require a rescue appendectomy. Recurrence rates of non-

operated patients within 1 year are as high as 20–30%

There is no doubt that appendectomy is the most efficient way of treating appendicitis, with success rates of

>95% as well as low overall morbidity and mortality.

Acute appendicitis is one of the most frequent disorders in abdominal surgery. Therefore,
appendectomy is a matter of significant interest in that field. Yet, four different techniques are
available:

 open appendectomy

 (conventional) laparoscopic appendectomy

 single port laparoscopic appendectomy and

 NOTES-appendectomy
Introduction
• Appendectomy was first described by Mc Burney in 1894. After being introduced, it rapidly
developed to one of the most common operations in abdominal surgery
• In 1983, Kurt Semm, a German gynaecologist, performed the first laparoscopic
appendectomy. Hardly accepted in the beginning, the method was used with growing
frequency in the following three decades. Meanwhile, laparoscopic appendectomy is well
established in the treatment of acute appendicitis. In Germany, LA rate increased from 47 to
86% between 2005 and 2009. This development could be supported by numerous
international publications.
The importance of the choice of the respective surgical technique is repeatedly discussed

controversially concerning optimal patient treatment as well as for economic aspects. Advantages

and disadvantages have been examined in an overwhelming number of studies.

For best possible patient care and economically seen, it is of particular importance to define the

optimal surgical treatment for appendectomy. This review analyzes the current evidence for

different approaches within the last five years to identify a “state of the art” procedure for acute

appendicitis.
Single Port Laparoscopic Appendectomy
Single incision laparoscopic appendectomy is an interesting variation of the conventional
laparoscopic technique. Data from current RCTs underline the method's safety and feasibility.
However, all studies failed to show clear advantages concerning perioperative parameters.
NOTES-Appendectomy
Natural orifice transluminal endoscopic surgery (NOTES) is the newest evolution of minimally
invasive surgery. A transgastric and a transvaginal abdominal access has been used in NOTES
appendectomy so far.
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