Laparoscopic appendectomy for appendicitis in uncommon situations: the advantages of a tailored approach

Palanivelu C, Rangarajan M, John SJ, Senthilkumar R, Madhankumar MV
Correspondence: Prof M Rangarajan, rangy68@hotmail.com

ABSTRACT
Introduction Appendicitis in unusual locations or situations always poses a diagnostic dilemma and surgery is never straightforward. We aim to highlight the advantages of laparoscopy, including our own modifications, in some unusual presentations of appendicitis.
Methods We treated a total of 7,210 patients with appendicitis over 14 years from 1992 to 2006. In this study, we included patients with subhepatic appendicitis (0.08 percent), appendectomy in midgut malrotation (0.09 percent), appendicitis in situs inversus totalis (0.01 percent) and appendicitis in the lateral pouch position (0.01 percent). All patients underwent laparoscopic appendectomy.
Results Patients with subhepatic appendicitis, appendicitis in situs inversus and appendicitis in the lateral pouch position had an uneventful postoperative course. For the patients who underwent appendectomy as part of the treatment for malrotation and the patient with the perforated subhepatic appendix, hospital stay was slightly prolonged.
Conclusion Most patients in our study did not have a confirmed preoperative diagnosis. Diagnostic laparoscopy through the umbilical port helped confirm the diagnosis. Port positions were then planned according to the exact position of the appendix and the technique was modified to suit each individual patient. In the surgical scenarios described here, laparoscopy is invaluable in both diagnosis and treatment.

Keywords: appendectomy, laparoscopic appendectomy, laparoscopic surgery, port sites
Singapore Med J 2007; 48(8): 737–740