Appendicitis surgery

Jump to navigation Jump to search

Appendicitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Appendicitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Diagnostic Scoring

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Appendicitis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Appendicitis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Appendicitis

CDC on Appendicitis

Appendicitis in the news

Blogs on Appendicitis

Directions to Hospitals Treating Appendicitis

Risk calculators and risk factors for Appendicitis

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.[1]
  • 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.[2]

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.[2]
  • 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.[2]

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.[3]

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.[2]
  • Young female, obese, and employed patients seem to benefit from the laparoscopic procedure more than other groups.[4]
  • 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.[3]

References

  1. Sartelli M, Viale P, Catena F, Ansaloni L, Moore E, Malangoni M; et al. (2013). "2013 WSES guidelines for management of intra-abdominal infections". World J Emerg Surg. 8 (1): 3. doi:10.1186/1749-7922-8-3. PMC 3545734. PMID 23294512.
  2. 2.0 2.1 2.2 2.3 Switzer, Noah J, Gill, Richdeep S, Karmali, Shahzeer (2012). "The Evolution of the Appendectomy: From Open to Laparoscopic to Single Incision". Scientifica. 2012: 1–5. doi:10.6064/2012/895469. PMID 10. Vancouver style error: punctuation (help)
  3. 3.0 3.1 "Appendicitis". Retrieved November 30, 2015.
  4. 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.

Template:WH Template:WS