Appendicitis surgery
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American Roentgen Ray Society Images of Appendicitis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery is the most effective therapy in treating appendicitis. Appendicectomy, or laproscopic removal of the appendix are the most effective therapies in treating appendicitis. Laproscopic surgery is the preferred method of surgery due to reduced complications and recovery time for the patient.
Surgery
Pre-Operative 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.
- Surgery may last from 15 minutes in typical appendicitis in thin patients to several hours in complicated cases.
- 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 tenderness, 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 of the hospital were reduced.
- Young female, obese, and employed patients seem to benefit from the laparoscopic procedure more than other groups. [1]
- Advances in modern surgery, anesthesia, antibiotics, and imaging have lead to an improved outcome and a significant reduction in mortality.
- Laparoscopic surgery has lead to a decreased length of hospital stay, reduced risk of wound infection, reduced amount of post-operative pain, and a more rapid return to daily activities for the patient.
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.