Appendicitis is an inflammation of the appendix that is attached to the appendix, a part of the large intestine. Like a dead end, this appendix has an inlet but no outlet. Digestive residues such as hardened stool (so-called "fecal stones") can easily accumulate here. Swelling of the mucous membrane or foreign bodies can also obstruct the inside of the appendix. This can then promote bacterial inflammation. Schoolchildren and young adults are most frequently affected. Infants and small children only very rarely develop appendicitis.

For pediatric surgeons, appendicitis is one of the most common diseases. Nevertheless, in individual cases it can be difficult to make the diagnosis quickly and correctly, as the typical signs are often absent (right-sided lower abdominal pain, increase in white blood cells, abdominal muscle tension, etc.). Ultrasound is used as an important diagnostic aid.

Normally, appendicitis begins with mild abdominal pain, which then becomes more severe. In many cases, the pain first occurs in the navel area and then "migrates" to the lower abdomen on the legal side after a while. Furthermore, walking or hopping on the right leg is no longer possible. Accompanying symptoms often include loss of appetite, nausea and vomiting. Slightly elevated temperatures may also occur.

If the diagnosis of "appendicitis" is made, the appendix must be removed by surgery. This should be done as soon as the diagnosis is made in order to prevent an imminent rupture of the appendix. In milder cases (mild or unclear symptoms, short duration of abdominal pain), it may be possible to wait and see if the inflammation does not resolve on its own under inpatient observation and bed rest.

If appendicitis is detected late, the appendix has already broken through and neighboring intestinal loops in the lower abdomen have stuck together to form a tight ball, this is a protective mechanism of the body. In this case, the peritoneum attempts to isolate the inflammatory process so that the body's own immune system can deal with the inflammation and the purulent inflammation does not spread throughout the abdominal cavity. If such a condition already exists, immediate surgery is generally not advisable. Instead, the healing process is supported by antibiotics administered via the vein. Only when this healing process is complete should the removal of the appendix a few weeks later (so-called "interval lobectomy") be considered.

 

 

In most cases, your child will be referred to our Clinical Department by your pediatrician with "suspected appendicitis". The first contact with us then takes place either in our pediatric surgery outpatient clinic or in the so-called "emergency outpatient clinic". Here we examine your child thoroughly and carry out a urine test and a blood test (to examine the white blood cells and an inflammatory protein produced by the liver (so-called "CRP" value)). We also examine the abdomen using ultrasound. If the symptoms are very acute and the suspicion of appendicitis is confirmed, we will operate on your child as soon as possible. In milder or unclear cases, however, we may wait a little longer. We will then admit your child as an inpatient, prescribe bed rest and regularly check the blood values in order to recognize a progressing inflammation in good time and then operate if necessary.

Operation (appendectomy)

We perform appendectomy exclusively laparoscopically (= via laparoscopy), regardless of age. This can be performed in two different ways.

Appendectomy with three trocars ("multitrocar appendectomy")

In this procedure, the pediatric surgeon makes a small incision at the navel through which a thin tube (trocar) is inserted into the abdominal cavity. Air is blown into the abdominal cavity through the trocar and a camera is inserted (laparoscopy). This allows the entire abdomen to be inspected. Two further working channels (trocars) are then inserted into the abdomen under visualization. The appendix is located and the blood vessels leading to it are closed with an electric hook. The surgeon places two loops over the lower end of the appendix (base) and tightens them. The appendix is then separated via these loops. A small stump of appendix remains. The severed appendix is either removed directly via the trocar at the navel or (if it is very thick, for example) placed in a special plastic bag and then pulled out through the navel. The small incision at the navel and the two small incisions in the lower abdomen are then closed again.

 

Appendectomy via a single access at the navel

(Synonyms: "single-incision appendectomy", SILS, "single-port appendectomy")
In this surgical method, the pediatric surgeon inserts a special trocar (so-called "SILS port") into the abdomen via the navel. The SILS port consists of a flexible rubber sleeve with 3 openings for inserting the laparoscopic instruments. The principle of appendectomy is the same as for appendectomy with three trocars, with the only difference that the additional trocars or skin incisions are omitted. As "only" the incision in the center of the navel is visible after the operation, some authors refer to this method as "scarless" surgery. Strictly speaking, a scar still remains, but it is usually cosmetically less prominent or more visible than with an appendectomy with three trocars.
Both procedures are used in our Clinical Department with a high level of patient satisfaction. We will discuss which procedure is most suitable for your child with you before the operation during the detailed surgical consultation.

After the procedure, your child will initially remain in the recovery area, where you will be able to sit at the bedside again. You will then be transferred to the normal ward. A few hours after the operation, your child will usually be able to eat again. After an uncomplicated appendectomy, a 2-3 day stay in hospital is usually sufficient. If the appendix has already broken through due to the inflammation (so-called "perforated appendicitis"), your child will have to stay in hospital for another 7-10 days and receive antibiotic treatment before being discharged.