Acute appendicitis is one of the most frequent surgical emergencies worldwide, affecting people of all ages. Traditionally, open appendectomy was the standard treatment, but it involved larger incisions, increased postoperative pain, and longer recovery times. The advent of laparoscopic appendectomy has revolutionized the management of appendicitis, offering a minimally invasive solution with reduced pain, shorter hospital stay, faster recovery, and superior cosmetic results. Dr. R.K. Mishra, a pioneer in minimally invasive surgery, has refined laparoscopic appendectomy techniques to improve safety, efficiency, and reproducibility, making it a preferred approach in both uncomplicated and complicated appendicitis cases.

Indications

Laparoscopic appendectomy by Dr. R.K. Mishra is indicated in:

Acute Appendicitis: Both early and advanced cases.

Complicated Appendicitis: Including perforation, abscess, or localized peritonitis, where minimally invasive management is feasible.

Incidental Appendectomy: During other laparoscopic procedures when removal of the appendix is warranted.

Diagnostic Uncertainty: Laparoscopy allows both diagnosis and treatment in cases where appendicitis is suspected but not confirmed.

Contraindications include patients with severe septicemia, hemodynamic instability, extensive intra-abdominal adhesions, or those unfit for general anesthesia.

Preoperative Evaluation

Preoperative assessment is critical for safe outcomes and includes:

Medical History and Physical Examination: Classic signs such as right lower quadrant pain, tenderness, and rebound tenderness are evaluated.

Laboratory Tests: Complete blood count, C-reactive protein, and renal and liver function tests.

Imaging: Ultrasound or CT scan for confirmation and assessment of complications.

Anesthesia Assessment: Ensuring patient fitness for general anesthesia.

Patients are counseled about the procedure, benefits, risks, and recovery expectations. Preoperative fasting and prophylactic antibiotics are standard.

Surgical Technique

Dr. R.K. Mishra’s approach emphasizes safety, efficiency, and minimal invasiveness. The procedure involves several critical steps:

Patient Positioning and Port Placement:
The patient is placed supine, with a slight Trendelenburg tilt and left tilt to move the intestines away from the operative field. Standard laparoscopic ports include:

10 mm infraumbilical port for the laparoscope

Two 5 mm ports in the left lower quadrant and suprapubic region for working instruments

Exploration and Appendix Identification:

Pneumoperitoneum is established, and the appendix is located. Adhesions, if present, are carefully dissected. The surrounding bowel and cecum are inspected for associated pathology.

Mesappendix Management:

The mesoappendix, containing the appendicular artery, is coagulated and divided using bipolar cautery or ultrasonic energy devices. Hemostasis is achieved meticulously to minimize intraoperative bleeding.

Appendix Base Ligation:

Dr. Mishra often employs advanced ligation techniques, including extracorporeal or intracorporeal knotting, to securely close the base of the appendix. These methods reduce operative time and prevent stump-related complications.

Appendix Division and Removal:

The appendix is divided distal to the ligature and placed in a retrieval bag to prevent contamination of the abdominal cavity. This ensures minimal risk of intra-abdominal infection.

Abdominal Cavity Inspection and Irrigation:

The peritoneal cavity is thoroughly inspected for bleeding, residual infection, or other pathology. Irrigation may be performed in complicated cases.

Port Closure:

After confirming hemostasis, ports are removed, and the fascia and skin are closed using absorbable sutures or subcuticular closure for optimal cosmetic results.

Postoperative Care

Postoperative recovery following laparoscopic appendectomy is rapid:

Early ambulation is encouraged to prevent thromboembolic events.

Oral intake can usually resume within 6–12 hours.

Analgesics are administered as needed for mild postoperative pain.

Wound care and monitoring for infection or intra-abdominal complications are essential.

Most patients are discharged within 24–48 hours, with full recovery expected in 7–10 days.

Outcomes and Advantages

Laparoscopic appendectomy by Dr. R.K. Mishra offers excellent outcomes:

Reduced Postoperative Pain: Minimally invasive approach limits tissue trauma.

Faster Recovery: Patients return to daily activities more quickly than after open surgery.

Superior Cosmetic Results: Small ports leave minimal visible scarring.

Low Complication Rates: Secure ligation techniques and careful dissection reduce risks of stump leakage, infection, and bleeding.

Applicability in Complicated Cases: Even perforated or gangrenous appendices can be safely managed laparoscopically.

Conclusion

Laparoscopic appendectomy by Dr. R.K. Mishra represents a modern, safe, and effective approach to the treatment of appendicitis. By combining minimally invasive techniques with meticulous surgical expertise, this procedure minimizes pain, shortens recovery, and provides superior cosmetic results. It has become a standard in both routine and complicated appendicitis cases, ensuring optimal outcomes and enhanced patient satisfaction.