Appendicitis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farwa Haideri [2]

Overview

Surgery is the mainstay of therapy for appendicitis. Either a laparoscopic approach or an open appendectomy is recommended.

Surgery

Surgical Procedure

• Both the laparoscopic approach or open appendectomy is associated with low morbidity and mortality.
• If the stomach is empty (no food in the past six hours) general anesthesia is usually used. Otherwise, spinal anesthesia can also be used.
• There are two types of surgeries used to treat appendicitis: open and laparoscopic appendectomies.
• In 1983, when the first described minimally invasive laparoscopic appendectomy was completed, surgical procedures began to shift away from the open appendectomy towards laparoscopic procedures.

Open Appendectomy

• The open appendectomy is the conventional approach for removing the appendix during surgery, though more recently, surgeons and patients both prefer the laparoscopic approach.
• In the open procedures, a 5 cm incision is made in the at the lateral border of the right rectus muscle in the abdomen, and the appendix is surgically removed.

Laparoscopic Surgery

• In the laparoscopic surgery, three small incisions are made in the abdomen with a small camera inserted to visualize the area of interest in the abdomen.
• Surgical tools are fed through trocars to minimize unnecessary surgical incisions in the patient. The appendix is surgically removed and taken out of the body through one of the small incisions.
  • If the findings reveal suppurative appendicitis with complications such as rupture, abscess, adhesions, etc., conversion to an open laparotomy may be necessary.
  • Open laparotomy incisions most often center on the area of maximum tenderness, McBurney's point, in the right lower quadrant of the abdomen.

Comparison of Surgical Treatments

• The open appendectomy is still considered the gold standard in complicated appendicitis because of increased intra-abdominal infectious complications during the post-operative period.
• The open appendectomy is a intraoperative backup plan for the laparoscopy approach when there is severe appendiceal inflammation or any other forms of adhesions from previous surgeries.
• The preference from a laparoscopic to an open appendectomy is 8.6%, yet this number is decreasing as surgeons become attuned to the laparoscopic approach.
• In patients under the age of 5 or those who are pregnant, laparotomy is preferred because the abdomen is too small for the requirements of a laparoscopy or the risk to the fetus is too high.
• Young female, obese, and employed patients seem to benefit from the laparoscopic procedure more than other groups.
• Laparoscopic surgery has resulted in decreased hospital stay, reduced risk of wound infection, reduced post-operative pain, and a faster return to daily activities for the patient.