Appendectomy

An appendectomy (sometimes called appendisectomy or appendicectomy) 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 recognized that many cases will resolve when treated perioperatively. In some cases the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix, causing transruptural flotation. This is a relative contraindication to surgery.

Appendectomy may be performed laparoscopically (this is called minimally invasive surgery) or as an open operation. Laparoscopy 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.

There have been some cases of auto-appendectomies, i.e. operating on yourself. One was performed by Dr Kane in 1921, but the operation was completed by his assistants. Another case is Leonid Rogozov who had to perform the operation on himself as he was the only surgeon on a remote Antarctic base.^[1]

Procedure

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

1. Antibiotics are given immediately if there are signs of sepsis, otherwise a single dose of prophylactic intravenous antibiotics is given immediately prior to surgery.
2. General anaesthesia is induced, with endotracheal intubation and full muscle relaxation, and the patient is positioned supine.
3. The abdomen is prepared and draped and is examined under anesthesia.
4. 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).
5. The various layers of the abdominal wall are then opened.
6. The effort is always to preserve the integrity of abdominal wall. Therefore, the External Oblique Aponeurosis is slitted along its fiber, and the internal oblique muscle is split along its length, not cut. As the two run at right angles to each other, this prevents later Incisional hernia.
7. On entering the peritoneum, the appendix is identified, mobilized and then ligated and divided at its base.
8. Some surgeons choose to bury the stump of the appendix by inverting it so it points into the caecum.
9. Each layer of the abdominal wall is then closed in turn.
10. The skin may be closed with staples or stitches.
11. The wound is dressed.
12. The patient will be brought to the recovery room.

Pregnancy

If appendicitis develops in a pregnant woman, an appendectomy is usually performed and should not harm the fetus.^[2] The risk of fetal death in the perioperative period after an appendectomy for early acute appendicitis is 3% to 5%. The risk of fetal death is 20% in perforated appendicitis.^[3]

Recovery

Recovery time from the operation varies from person to person. Some will take up to three weeks before being completely active; for others it can be a matter of days. 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 2–3 inch scar, which will initially be heavily bruised.^[4]

References

External links

• Laproscopic Appendectomy Video (includes case presentation)
• Open appendectomy, appendectomy Part of the operative howto series, explaining the steps in carrying out an open appendectomy
• Open & Laparoscopic appendectomy, appendectomy Open and Laparoscopic appendectomy
• A video of the procedure
• Another video of the procedure (Either Requires Windows Media Player and will not load in Firefox 1.5; or use this direct link with any player that can play .wmv files.)