An appendectomy (American English) or appendicectomy (British English) is a surgical operation in which the vermiform appendix (a portion of the intestine) is removed. Appendectomy is normally performed as an urgent or emergency procedure to treat complicated acute appendicitis. Appendectomy may be performed laparoscopically (as minimally invasive surgery) or as an open operation. Over the 2010s, surgical practice has increasingly moved towards routinely offering laparoscopic appendicectomy; for example, in the United Kingdom over 95% of adult appendicectomies are planned as laparoscopic procedures. Laparoscopy is often used if the diagnosis is in doubt, or to leave a 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 occasionally requires a lower midline laparotomy. Complicated (perforated) appendicitis should undergo prompt surgical intervention. There has been significant recent trial evidence that uncomplicated appendicitis can be treated with either antibiotics or appendicectomy, with 51% of those treated with antibiotics avoiding an appendectomy after 3 years. After appendicectomy, the main difference in treatment is the length of time the antibiotics are administered. For uncomplicated appendicitis, antibiotics should be continued up to 24 hours postoperatively. For complicated appendicitis, antibiotics should be continued for anywhere between 3 and 7 days. An interval appendectomy is generally performed 6–8 weeks after conservative management with antibiotics for special cases, such as perforated appendicitis. Delay of appendectomy 24 hours after admission for symptoms of appendicitis has not been shown to increase the risk of perforation or other complications.
Procedure
In general terms, the procedure for an open appendectomy is:
Antibiotics are given immediately if signs of actual sepsis are seen (in appendicitis, sepsis and bacteremia usually only occurs at some point after rupture, once peritonitis has begun), or if there is reasonable suspicion that the appendix has ruptured (e.g., on imaging) or if the onset of peritonitis – which will lead to full sepsis if not quickly treated – is suspected; otherwise, a single dose of prophylactic intravenous antibiotics is given immediately before 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 anesthesia. 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 to the umbilicus), which represents the most common position of the base of the appendix. The various layers of the abdominal wall are opened. To preserve the integrity of the abdominal wall, the external oblique aponeurosis is split along the line of its fibers, as is the internal oblique muscle. As the two run at right angles to each other, this reduces the risk of later incisional hernia. On entering the peritoneum, the appendix is identified, mobilized, and then ligated and divided at its base. Some surgeons choose to bury the stump of the appendix by inverting it so it points into the caecum. Each layer of the abdominal wall is then closed in turn. The skin may be closed with staples or stitches. The wound is dressed. The patient is brought to the recovery room.
Incisions The standardization of an incision is not the best practice when performing an appendectomy, given that the appendix is a mobile organ. A physical exam should be performed before the operation, and the incision should be chosen based on the point of maximal tenderness to palpation. These incisions are placed for an appendectomy:
McBurney's incision, also known as gridiron incision Lanz incision Rutherford Morison incision Paramedian incision
… excerpt ends here. Continue reading the full article.
