Appendicitis surgery: Difference between revisions
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** If the findings reveal [[suppuration|suppurative]] appendicitis with complications such as rupture, abscess, adhesions, etc., conversion to open laparotomy may be necessary. | ** If the findings reveal [[suppuration|suppurative]] appendicitis with complications such as rupture, abscess, adhesions, etc., conversion to open laparotomy may be necessary. | ||
** Open laparotomy incisions most often center on the area of maximum tenderess, [[McBurney's point]], in the right lower quadrant of the abdomen. | ** Open laparotomy incisions most often center on the area of maximum tenderess, [[McBurney's point]], in the right lower quadrant of the abdomen. | ||
==Comparison of Surgical Treatments== | |||
* 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> | |||
==References== | |||
{{reflist|2}} | |||
Revision as of 17:30, 20 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pre-Operation Preparations
- The treatment begins by keeping the patient from eating or drinking anything, even water, in preparation for surgery.
- An intravenous drip is used to hydrate the patient.
Surgical Procedure
- If the stomach is empty (no food in the past six hours) general anaesthesia is usually used. Otherwise, spinal anaesthesia may be used.
- There are two types of surgeries used to treat appendicitis: Open and laparoscopic appendectomies
Open
- In open procedures, a relatively large incision is made in the abdomen and the appendix is surgically removed in an open abdomen.
Laparoscopic
- In the laparoscopic surgery approach, 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 open laparotomy may be necessary.
- Open laparotomy incisions most often center on the area of maximum tenderess, McBurney's point, in the right lower quadrant of the abdomen.
Comparison of Surgical Treatments
- 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).
- Wound infections were less likely after laparoscopic appendicectomy than after open appendicectomy (odds ratio 0.45; CI 0.35 to 0.58)
- 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. [1]
References
- ↑ Sauerland S, Lefering R, Neugebauer EA (2004). "Laparoscopic versus open surgery for suspected appendicitis". Cochrane Database Syst Rev (4): CD001546. doi:10.1002/14651858.CD001546.pub2. PMID 15495014.