Laparoscopic Appendectomy

Management of Acceptable Complications

Post-operative Sepsis
The irrigation of the intra-abdominal cavity with copious amounts of normal saline under
direct vision has decreased the number of post-operative septic episodes or postoperative
intra-abdominal abscesses. However, several patients were readmitted with severe
abdominal pain and sepsis within ten days after this procedure. Our protocol mandates the
following in this clinical setting: 1) Admission to the surgical service, 2) IV antibiotics
(Cefizox™ and Flagyl™), 3) Computerized Tomography scan (preferably Spiral) of the
abdomen and pelvis, 4) If no localized fluid collection or abscess can be demonstrated on
the CT, the patients will continued IV antibiotics only, 5) If an abscess is demonstrated, the
patient will undergo a CT guided drainage versus a laparoscopic drainage.

Trocar Site Infection - Wound Infection

Prior to the introduction of the ENDOCATCH™ instrument, a significant number of trocar
site infections was reported by our surgical team. These incisions were opened at the
bedside and drained.

With the use of the ENDOCATCH™ instrument to remove the infected specimen from the
intra-abdominal cavity, we only reported one wound infection. The irrigation of the trocar
site with normal saline at the end of the procedure should also always be done when gross
contamination occurred.

Inability to Find the Appendix

In patients with severe, perforated appendicitis, the appendix may be difficult to locate. In
this clinical settings, the cecum should be well visualized, dissected and exposed. The base
of the appendix is at the confluence of the colic tenias. Persistence is key.

Severe, Acute, Necrotizing Appendicitis

In some cases of severe, acute, necrotizing appendicitis the base of the appendix may not
be suitable for transection with a MULTIFIRE ENDOGIA™. It may be technically easier and
safer to perform a [partial or full] "cecectomy" using the same stapling device.
http://www.laparoscopy.net/appy/appy8.htm

Management after laparoscopy

You are discharged on a a regular diet.

You have no physical restrictions.
 You should walk at least one to two miles per day.
If you become nauseated or start vomiting, have diarrhea or have a fever, notify your
surgeon.
If you were prescribed oral antibiotics, complete the entire treatment.

You should be given an appointment a week post discharge from the hospital.

Use Advil™ for moderate pain control. For severe pain, use the prescribed pain
medication.

You can drive as long as you do not take narcotic pain medication.

You may return to work when you feel ready.

Management of Acceptable Complications

Post-operative Sepsis
The irrigation of the intra-abdominal cavity with copious amounts of normal saline under
direct vision has decreased the number of post-operative septic episodes or postoperative
intra-abdominal abscesses. However, several patients were readmitted with severe
abdominal pain and sepsis within ten days after this procedure. Our protocol mandates the
following in this clinical setting: 1) Admission to the surgical service, 2) IV antibiotics
(Cefizox™ and Flagyl™), 3) Computerized Tomography scan (preferably Spiral) of the
abdomen and pelvis, 4) If no localized fluid collection or abscess can be demonstrated on
the CT, the patients will continued IV antibiotics only, 5) If an abscess is demonstrated, the
patient will undergo a CT guided drainage versus a laparoscopic drainage.

Trocar Site Infection - Wound Infection

Prior to the introduction of the ENDOCATCH™ instrument, a significant number of trocar
site infections was reported by our surgical team. These incisions were opened at the
bedside and drained.

With the use of the ENDOCATCH™ instrument to remove the infected specimen from the
intra-abdominal cavity, we only reported one wound infection. The irrigation of the trocar
site with normal saline at the end of the procedure should also always be done when gross
contamination occurred.

Inability to Find the Appendix

In patients with severe, perforated appendicitis, the appendix may be difficult to locate. In
this clinical settings, the cecum should be well visualized, dissected and exposed. The base
of the appendix is at the confluence of the colic tenias. Persistence is key.

Severe, Acute, Necrotizing Appendicitis

In some cases of severe, acute, necrotizing appendicitis the base of the appendix may not
be suitable for transection with a MULTIFIRE ENDOGIA™. It may be technically easier and
safer to perform a [partial or full] "cecectomy" using the same stapling device.