Appendectomy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Mohammed A. Sbeih, M.D.[2]

An Appendicectomy in progress

Overview

An Appendicectomy (or appendectomy) is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis; it is now recognised that many cases will resolve when treated non-operatively. In some cases the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix. This is a relative contraindication to surgery.

Many patients do not seek medical attention early when they have symptoms, this delays the diagnosis of appendicitis,and some cases could be missed. Some surgeons accepts negative appendectomies up to 15 percent of cases, so they intervene aggressively with suspicious cases. The use of imaging studies before going through the surgery reduces the rate of negative appendictomy to less than 10 percent according to some studies.

Anatomy and physiology

The appendix is a part of small intestine, it is a small, finger-like projection located in the right lower quadrant of abdomen. It is attached to the large intestine through a small opening, which allow fluids and other materials to flow in and out of the appendix, When this opening becomes blocked, there is a buildup of secretions and fluids in the appendix. It becomes swollen and may be infected (Appendicitis), also it can ruptures, resulting in peritonitis.

An Appendectomy is done for Appendicitis. The condition can be hard to be diagnosed, especially in children, older people, and women of childbearing age, since there are some medical conditions that mimics Appendicitis in their symptoms. Most often, the first symptom is vague abdominal pain around the umbilicus. The pain may be mild at first, but it becomes sharp and severe. The pain often moves into the right lower abdomen and becomes more focused in this area.

Other symptoms include:

• Diarrhea or constipation.
• Fever (usually not very high).
• Nausea and vomiting.
• Reduced appetite.

It is not known if it has any function in the human body.

Treatments

An appendectomy is the only treatment for appendicitis. There are two types of operations used to remove the appendix: the traditional open procedure and a laparoscopic procedure. Laparoscopic surgery is often used if the diagnosis is in doubt, or if it is desirable to hide the scars in the umbilicus or in the pubic hair line. Recovery may be a little quicker with laparoscopic surgery; the procedure is more expensive and resource-intensive than open surgery and generally takes a little longer, with the (low in most patients) additional risks associated with pneumoperitoneum (inflating the abdomen with gas). Advanced pelvic sepsis occasionally requires a lower midline laparotomy.

The procedure

In general terms, the procedure for an open Appendicectomy is as follows.

Antibiotics are given immediately if there are signs of sepsis, otherwise a single dose of prophylactic intravenous antibiotics is given immediately prior to surgery.

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

The abdomen is prepared and draped and is examined under anaesthesia. If a mass is present, the incision is made over the mass; otherwise, the incision is made over McBurney's point, one third of the way from the anterior superior iliac spine (ASIS) and the umbilicus; this represents the position of the base of the appendix (the position of the tip is variable).

An inflamed appendix can be life-threatening, particularly if the patient is out of reach of medical care. Historical records show a number of appendicectomies carried out by unskilled ad hoc surgeons, communicating with a base hospital by telephone or even telegraph.

If appendicitis develops in a pregnant woman, an Appendicectomy is usually performed and should not harm the fetus.

Prophylactic Appendicectomy

To find the cause of unexplained abdominal pain, exploratory surgery is sometimes performed. If the appendix is NOT the cause of symptoms, the surgeon will thoroughly check the other abdominal organs and remove the appendix anyway, to prevent it from becoming a problem in the future.

When abdominal surgery is performed for an entirely different reason (e.g. hysterectomy or bowel resection), the surgeon sometimes decides to perform an Appendicectomy in addition to the intended procedure, to eliminate the possible need of a future surgery just to remove the appendix. However, recent findings on the possible usefulness of the appendix has led to an abatement of this practice.

Recovery

Recovery time from the operation can vary from person to person. Some will take up to 3 weeks before being completely active. Others it can be a matter of days. Roy Halladay of the Toronto Blue Jays baseball team, recovered from his Appendicectomy in under 3 weeks, to return to the mound and win 3 straight games. In the case of a laparoscopic operation, the patient will have three stapled scars of about an inch in length, between the navel and pubic hair line. When a laparotomy has been performed, the patient will have a 2-4 inch scar, which will initially be heavily bruised.

Scar and Bruise 2 days after operation.

External links

• A video of the procedure
• Another video of the procedure (Either Requires Windows Media Player and will not load in Firefox 1.5; or usethis direct link with any player that can play .wmv files.)
• Appendicectomy laparoscopic : Operation Script on Wikisurgery.
• Appendicectomy laparoscopic adult: Information for patients on Wiksiurgery.
• Appendicectomy open adult: Information for patients on Wikisurgery.
• Appendicectomy open child: Information for patients on Wikisurgery.