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| ==Treatment== | | ==Treatment== |
| | | :[[Appendicitis medical therapy|Medical Therapy]] | [[Appendicitis surgery|Surgery]] |
| The treatment begins by keeping the patient from [[fasting|eating or drinking anything]], even water, in preparation for surgery. An intravenous drip is used to hydrate the patient. [[Antibiotic]]s given intravenously such as cefuroxime and metronidazole may be administered early to help kill bacteria and thus reduce the spread of infection in the abdomen and postoperative complications in the abdomen or wound. Equivocal cases may become more difficult to assess with antibiotic treatment and benefit from serieal examinations. If the stomach is empty (no food in the past six hours) general anaesthesia is usually used. Otherwise, spinal anaesthesia may be used.
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| The [[surgery|surgical]] procedure for the removal of the appendix is called an ''[[appendicectomy]]'' (also known as an ''appendectomy''). Often now the operation can be performed via a [[laparoscopic]] approach, or via three small incisions with a camera to visualize the area of interest in the abdomen. If the findings reveal suppurative appendicitis with complications such as rupture, abscess, adhesions, etc., conversion to open laparotomy may be necessary. An open laparotomy incision if required most often centers on the area of maximum tenderess, [[McBurney's point]], in the right lower quadrant. A transverse or a gridiron diagonal incision is used most commonly.
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| According to a [[meta-analysis]] from the [[Cochrane Collaboration]] comparing [[laparoscopic]] and open procedures, [[laparoscopic]] procedures seem to have various advantages over the open procedure. Wound infections were less likely after [[laparoscopic]] [[appendicectomy]] than after open appendicectomy ([[odds ratio]] 0.45; CI 0.35 to 0.58), but the incidence of intraabdominal abscesses was increased ([[odds ratio]] 2.48; CI 1.45 to 4.21). The duration of surgery was 12 minutes (CI 7 to 16) longer for laparoscopic procedures. Pain on day 1 after surgery was reduced after laparoscopic procedures by 9 mm (CI 5 to 13 mm) on a 100 mm visual analogue scale. Hospital stay was shortened by 1.1 day (CI 0.6 to 1.5). Return to normal activity, work, and sport occurred earlier after laparoscopic procedures than after open procedures. While the operation costs of laparoscopic procedures were significantly higher, the costs outside hospital were reduced. Young female, obese, and employed patients seem to benefit from the laparoscopic procedure more than other groups. <ref name="pmid15495014">{{cite journal |author=Sauerland S, Lefering R, Neugebauer EA |title=Laparoscopic versus open surgery for suspected appendicitis |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD001546 |year=2004 |pmid=15495014 |doi=10.1002/14651858.CD001546.pub2}}</ref>
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| Surgery may last from 15 minutes in typical appendicitis in thin patients to several hours in complicated cases. Hospital lengths of stay usually range from overnight to a matter of days (rarely weeks in complicated cases.) The pain is not always constant, in some cases it can stop for a day and then come back.
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[Category:emergency medicine]] | | [[Category:emergency medicine]] |
