Appendectomy

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A appendix (known outside the United States as appendisectomy or appendicectomy ) is a surgical operation where appendix vermiform (part of the intestine) is removed. Appendectomy is usually performed as an urgent or emergency procedure to treat acute appendicitis.

Appendectomy may be done laparoscopically (as minimally invasive surgery) or as open surgery. Laparoscopy is often used if the diagnosis is in doubt, or to leave less visible surgical scar. Recovery may be slightly faster after laparoscopic surgery, although the laparoscopic procedure itself is more expensive and resource intensive than open surgery and generally takes longer. Advanced pelvic sepsis sometimes requires a lower midline laparotomy. In US adults, mortality 30 days after appendectomy is 1.8%.

Video Appendectomy

Procedures

In general, the procedure for open appendectomy is: Antibiotics are given immediately if signs of actual sepsis are seen (in appendicitis, sepsis and bacteremia usually occurs only at some point after rupture, once peritonitis has begun), or if there is a reasonable suspicion that the appendix has ruptured. (eg, on imaging) or if onset of peritonitis - which will cause full sepsis if not treated promptly - is suspected; if not, a single dose of prophylactic intravenous antibiotics is given immediately before surgery.

General anesthesia is induced, with endotracheal intubation and full muscle relaxation, and the patient is supine.

The abdomen is prepared and wrapped and examined under anesthesia.

If there is mass, an incision is made above the mass. Otherwise, the incision is made above the McBurney point (one-third of the road from the anterior superior iliac spine to the umbilicus), which represents the most common position of the appendix base.

Various layers of abdominal wall are opened. To maintain the integrity of the abdominal wall, external oblique aponeurosis is shared along the fiber line, such as the internal oblique muscle. When both run in right angles to each other, this reduces the risk of incisional hernia later.

Upon entering the peritoneum, the appendix is ​​identified, mobilized, and then ligated and subdivided.

Some surgeons choose to bury the appendary stump by turning it so that it leads to the cecum.

Each layer of abdominal wall is then closed in turn.

The skin may be covered with staples or stitches.

His wound was dressed.

The patient is taken to the recovery room.

Incision

This incision is placed for appendicitis surgery: 1) McBurney incision, also known as iron grid incision 2) Lanz incision 3) Rutherford morrision 4) Parathy incision

Over the past decade, the results of laparoscopic appendicitis have been compared favorably for open apendectomy due to decreased pain, fewer postoperative complications, shorter hospitalizations, earlier mobilization, back to work, and better cosmesis. However, despite these advantages, efforts are still being made to reduce abdominal incisions and scars seen after laparoscopy. Recent research has led to the development of natural transluminal endoscopic surgery (NOTE). However, many difficulties need to be addressed before the wider clinical application of the NOTE is adopted, including complications such as the opening of hollow viscera, the failed seams, the lack of fully developed instrumentation, and the need for a reliable cost-benefit analysis.

Many surgeons have tried to reduce incisional morbidity and improve cosmetic results in laparoscopic appendicectomy by using fewer and smaller ports. Kollmar et al. describes moving a laparoscopic incision to hide it in natural camouflage like a suprapubic hairline to improve cosmesis. In addition, the report in the literature shows that the appendectomy of minilaparoscopy using a 2- or 3-mm or even smaller instrument together with a 12-mm port minimizes pain and increases cosmesis. More recently, research by Ates et al. and Roberts et al. has described variants of an intracorporeal single-port laparoscopic appendage based on good clinical outcomes.

Also, the upward trend toward laparoscopic surgery with one incision (SILS), using a special multiport umbilical trousers. With SILS, a more conventional view of the field of operation is seen compared to the NOTE. The equipment used for SILS is familiar to surgeons already undergoing laparoscopic surgery. Most importantly, it's easy to turn SILS into a conventional laparoscopy by adding multiple trocars; This conversion to conventional laparoscopy is called 'port rescue'. SILS has proven to be feasible, reasonably safe, and profitable cosmetically, compared to standard laparoscopy. However, this new technique involves special instruments and is more difficult to learn because of the loss of triangulation, instrument clash, cross-triangulation, and lack of maneuverability. Also, additional problems of decreased exposure and additional financial burden in the procurement of specialized or arched special articulate or coaxial instruments exist. SILS is still growing, used successfully in many centers, but in some ways before it becomes mainstream. This limits its use extensively, especially in rural or peripheral centers with limited resources.

Maps Appendectomy

Pregnancy

If appendicitis develops in pregnant women, appendicitis is usually performed and should not harm the fetus. The risk of preterm birth is about 10%. The risk of fetal death in the perioperative period after appendectomy for acute early appendicitis is 3 to 5%. The risk of fetal death is 20% in perforated appendicitis.

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Recovery

A study from 2010 found that the average hospital stay for patients with appendicitis in the United States is 1.8 days. For patients with hollow (broken) appendices, the average length of stay was 5.2 days.

Recovery time from surgery varies from person to person. Some take up to three weeks before being fully active; for others, it could be just a few days. In the case of laparoscopic surgery, the patient has three stapled scars along the 2.5 cm, between the hairline of the navel and the genitals. When an open appendectomy has been performed, the patient has a 2- to 3 inch (5-7.5 cm) scar, which will initially be very bruised.

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Epidemiology

Approximately 327,000 appendixes were performed during the US hospital stay in 2011, a rate of 10.5 procedures per 10,000 population. Appendectomy accounted for 2.1% of all operating room procedures in 2011.

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History

The first successful recorded appendect was on December 6, 1735, at St. Hospital. George in London, when the French surgeon Claudius Amyand described the existence of a hollowed-out appendix in the inguinal hernia sac of an 11-year-old boy. The organ was apparently punctured by the pin the boy had swallowed. The patient, Hanvil Andersen, made a recovery and was discharged a month later.

Harry Hancock performed his first stomach surgery for appendicitis in 1848, but he did not remove his appendix. In 1889 in New York City, Charles McBurney described the presentation and pathogenesis of appendicitis accurately and developed the teaching that early appendicitis is the best treatment to avoid perforation and peritonitis.

Several cases of autoappendectomies have occurred. One of them was tried by Evan O'Neill Kane in 1921, but the operation was completed by his assistants. The other is Leonid Rogozov, who must perform surgery on himself because he is the only doctor in a remote Antarctic base.

On September 13, 1980, Kurt Semm performed the first laparoscopic appendectomy that paved the way for a much wider minimally invasive surgical application.

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Cost

United States

While appendectomy is a standard surgical procedure, the cost has been found to vary considerably in the United States. A 2012 study analyzed 2009 data from nearly 20,000 adult patients treated for appendicitis in California hospitals. The investigators examined "only episodes of acute appendicitis" involving "visits for patients aged 18 to 59 with inpatients lasting less than four days with routine discharge to the home." The lowest cost for removing attachments is $ 1,529 and the highest is $ 182,955, more than 120 times greater. The median value is $ 33,611. While the study was limited to California, the researchers showed that the results apply anywhere in the United States. Many, but not all, patients, are covered by some sort of health insurance.

A study by the Research and Quality Health Agency found that in 2010, the average cost to live in the United States involving appendicitis was $ 7,800. To stay where the appendix has broken, the average cost is $ 12,800. Most of the patients seen in the hospital are covered by private insurance.

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See also

• List of operations by type

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References

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External links

• Open Appendectomy: Video operating procedure
• Laparoscopic Apendectomy Video (including case presentation)
• Open appendectomy, appendectomy Part of the howto series of operations, describes the steps in performing an open appendom
• Open & amp; Laparoscopic appendix, Appendectomy Open Appendectomy and Laparoscopy
• Video procedure
• Another video from the procedure (Both Requires Windows Media Player and will not be loaded in Firefox 1.5 or used with any player that can play.wmv files.)

Source of the article : Wikipedia