Case Study: Enhanced Recovery in Acute Appendicitis: Multidisciplinary Laparoscopic Management

Abstract

This case study describes a 29-year-old male presenting with acute appendicitis managed through laparoscopic appendectomy integrated with enhanced recovery after surgery (ERAS) principles. The patient benefited from timely diagnosis, minimally invasive intervention, and structured perioperative care including early mobilization and nutritional optimization. He achieved complete recovery without complications and resumed work within a week. This case emphasizes the role of early clinical assessment, precision imaging, and evidence-based perioperative strategies in optimizing surgical outcomes. The report also highlights the importance of patient education, pain control, and multidisciplinary collaboration in promoting faster recovery and reducing postoperative morbidity.

Introduction

Acute appendicitis remains one of the most common surgical emergencies worldwide, affecting approximately 7% of the population during their lifetime. Despite being a well-recognized condition, variations in presentation and diagnostic ambiguity can delay management, increasing the risk of perforation and complications. The evolution of laparoscopic surgery has revolutionized appendectomy by minimizing tissue trauma, reducing infection rates, and expediting recovery.

Modern surgical care now incorporates Enhanced Recovery After Surgery (ERAS) protocols that integrate multimodal analgesia, early feeding, mobilization, and patient-centered education to optimize physiological recovery. This case study demonstrates how prompt diagnosis, minimally invasive technique, and multidisciplinary postoperative management can enhance clinical outcomes in a young patient presenting with acute appendicitis.

Patient Information

Age / Gender: 29-year-old male
Occupation: Marketing executive
Marital Status: Married
Medical History: No known comorbidities
Surgical History: None
Family History: Non-contributory
Social History: Non-smoker, moderate physical activity, no alcohol use
Current Medications: None
Chief Complaints: Abdominal pain in the right lower quadrant for 24 hours, low-grade fever, and nausea

Clinical Findings

Symptoms:

• Sudden-onset periumbilical pain migrating to the right lower quadrant

• Low-grade fever (100°F)

• Mild nausea and anorexia

Physical Examination:

• Temperature: 100.4°F

• Pulse: 92 bpm

• BP: 118/76 mmHg

• Abdomen: Tenderness and rebound in right iliac fossa, guarding present

• No palpable mass, bowel sounds normal

• Digital rectal exam: Mild tenderness on the right side

Timeline

Initial Presentation (April 2024):
Patient presented with right lower quadrant pain and nausea for 24 hours. Physical examination suggested appendicitis; laboratory and imaging studies were ordered.

Diagnostic Workup (Same Day):

• CBC: WBC 13,200/mm³ (neutrophilia 86%)

• CRP: Elevated (24 mg/L)

• Ultrasound Abdomen: Non-compressible tubular structure 8 mm in diameter in right iliac fossa, suggestive of acute appendicitis

• CT Abdomen (confirmatory): Inflamed appendix without perforation or abscess formation

Preoperative Optimization (April 2024):

Patient kept nil per oral (NPO), started on intravenous fluids and broad-spectrum antibiotics (ceftriaxone and metronidazole). Surgical consent obtained.

Surgical Intervention (Next Day):
Laparoscopic appendectomy performed under general anesthesia using three-port technique. Inflamed appendix visualized and removed. No perforation or abscess found.

Postoperative Care:
Pain managed with multimodal analgesia (paracetamol + NSAIDs). Early oral intake initiated 6 hours post-surgery, followed by ambulation after 12 hours.

Discharge (Postoperative Day 2):
Patient discharged with oral antibiotics and dietary advice under ERAS guidelines.

Follow-Up (7 Days Later):
Complete wound healing, no complications, returned to normal physical activity.

Diagnostic Assessment

Laboratory Findings:

• WBC: 13,200/mm³ (↑)

• CRP: Elevated

• Renal and liver function: Normal

Imaging Findings:

• Ultrasound: Tubular, non-compressible appendix with wall thickening

• CT Scan: Confirmed diagnosis; no perforation, abscess, or appendicolith

Risk Evaluation:

• ASA Physical Status: Class I

• No significant anesthetic or operative risk

Therapeutic Intervention

Step 1 – Preoperative Preparation

• NPO for 6 hours before surgery

• IV hydration and electrolyte correction

• Single-dose prophylactic antibiotics (ceftriaxone + metronidazole)

• Patient counseling and consent regarding laparoscopic approach

Step 2 – Surgical Procedure

• Three-port laparoscopic appendectomy under general anesthesia

• Pneumoperitoneum established with CO₂ insufflation

• Appendix identified, mesoappendix ligated, and appendix removed

• No drain required; minimal blood loss (<20 mL)

• Skin closed with absorbable sutures

Step 3 – Postoperative Care and Rehabilitation

• Early ambulation after 12 hours

• Oral fluids resumed at 6 hours post-op; soft diet on day 1

• Pain managed using multimodal analgesia (acetaminophen + NSAID)

• Discharged on day 2 with instructions for wound care and light activity

• Follow-up for suture site inspection and dietary counseling

Challenges Faced

• Diagnostic Ambiguity: Mild clinical presentation delayed initial suspicion.

• Patient Anxiety: Addressed through preoperative counseling and reassurance.

• Early Return to Work: Managed by implementing ERAS and physiotherapy-guided mobility exercises.

Follow-Up and Outcomes

• Uneventful postoperative recovery

• No wound infection or intra-abdominal complications

• Resumed office work within 7 days

• Follow-up ultrasound (3 weeks): Normal findings

• Improved confidence in physical health and adherence to dietary recommendations

Discussion

This case highlights how laparoscopic appendectomy, combined with enhanced recovery protocols, transforms patient outcomes in general surgery. Laparoscopy offers superior visualization, reduced postoperative pain, shorter hospital stay, and faster return to normal function compared to open appendectomy. It also minimizes surgical trauma, lowers infection risk, and improves cosmetic outcomes, contributing to overall patient satisfaction and quality of life.

ERAS protocols integrate several evidence-based strategies—early feeding, minimal narcotic use, and early ambulation—that collectively minimize surgical stress response, enhance bowel recovery, and shorten hospitalization. These protocols are applicable across general surgical domains, improving both patient satisfaction and hospital efficiency. Additional measures such as optimized fluid management, multimodal analgesia, and early mobilization work synergistically to accelerate recovery and reduce postoperative complications.

Studies have shown that ERAS-guided laparoscopic appendectomy reduces mean hospital stay from 4 days to 1.5 days and postoperative complication rates by nearly 30%. This aligns with the present case, where structured perioperative care, close monitoring, and timely intervention led to rapid recovery and minimal pain.

Multidisciplinary coordination—surgeon, anesthesiologist, nurse, nutritionist, and physiotherapist was key to ensuring patient-centered care. The emphasis on patient education empowered adherence, reduced anxiety, and promoted early mobilization. Continuous communication, individualized recovery planning, and postoperative follow-up ensured safety, prevented readmissions, and supported long-term well-being. This holistic approach demonstrates how precision surgery, evidence-based perioperative care, and personalized recovery plans yield superior outcomes, reflecting the modern evolution of general surgical practice toward faster, safer, and more sustainable patient-centered care.

Key Takeaways

• Laparoscopic surgery minimizes postoperative pain and speeds recovery.

• ERAS protocols enhance surgical outcomes and reduce complications.

• Multidisciplinary care ensures comprehensive perioperative management.

• Early mobilization and patient education are critical to fast recovery.

• Evidence-based, patient-centered surgical care improves both outcomes and satisfaction.

Patient’s Perspective

“I was worried when I heard I needed surgery, but the doctors explained every step clearly. The laparoscopic approach caused minimal pain, and I could walk the same evening. I was surprised at how quickly I recovered and returned to work within a week.”

Conclusion

This case underscores that integrating laparoscopic surgical precision with enhanced recovery principles provides optimal outcomes in acute appendicitis management. Early diagnosis, tailored perioperative care, and patient engagement minimized complications and accelerated recovery. The success of this approach reflects the growing emphasis on multidisciplinary, evidence-based general surgery, focusing not just on operative success but also on functional recovery, patient satisfaction, and long-term well-being.

A holistic framework combining technology, clinical skill, and human-centered care represents the future of general surgery delivering faster, safer, and more sustainable outcomes. Moreover, incorporating continuous postoperative monitoring, digital health tools, and patient education enhances compliance and long-term wellness. The synergy between minimally invasive techniques, standardized care pathways, and personalized rehabilitation ensures superior surgical outcomes, reduced readmission rates, and improved quality of life. This comprehensive approach not only advances clinical effectiveness but also redefines patient-centered care in modern surgical practice, emphasizing the integration of innovation, empathy, and precision at every stage of recovery.

References

1. Di Saverio S, et al. (2020). Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery.

2. Ljungqvist O, et al. (2017). Enhanced Recovery After Surgery: A review. JAMA Surgery.

3. Sauerland S, et al. (2010). Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev.

4. Kehlet H. (2018). ERAS: The new standard in surgical care. Annals of Surgery.

5. NICE (2023). Appendicitis: Diagnosis and Management. National Institute for Health and Care Excellence.

Read more such content on @ Hidoc Dr | Medical Learning App for Doctors