APPENDICECTOMY
An Appendicectomy may be performed laparoscopically 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.
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. 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.
Emergency Appendectomy in India
An inflamed appendix can be life-threatening, particularly if the patient is out of reach of medical care. Historical records show a number of appendectomies carried out by unskilled ad hoc surgeons, communicating with a base hospital by telephone or even telegraph.
Prophylactic Appendectomy in India
To find the cause of unexplained abdominal pain, exploratory surgery is sometimes performed. If the cause of symptoms does not lie in the appendix, the surgeon will thoroughly check the other abdominal organs and remove the appendix anyway, to prevent problems in the future. Recent findings on the possible usefulness of the appendix has led to an abatement of this practice.
How Does Appendicitis Develop ?
Abdominal pain is the hallmark of appendicitis, usually starting in the mid-abdomen, before travelling down to the right, to the area over the appendix. Symptoms such as nausea, vomiting and constipation may also be experienced.
If left untreated, the inflammation may worsen until the appendix ruptures. The contents of the appendix, which include faecal material and bacteria, then spill into the normally sterile peritoneal cavity. This can lead to peritonitis, a life-threatening inflammation of the peritoneum (abdominal lining). Abscesses may develop, threatening adjacent organs with infection. The passage of food through the intestines slows or stops. Shock, intestinal blockage, intense pain, and even death, may follow.
The diagnosis of appendicitis is mainly clinical. Laparoscopy is now commonly used for investigation and, if necessary, the removal of the appendix. This procedure involves looking into the abdominal cavity with a small telescope. Surgeons cannot predict whether or not an inflamed appendix will rupture. If they suspect abdominal pain is caused by appendicitis, they will remove the appendix as soon as possible in case a rupture occurs. Sometimes the pain is incorrectly diagnosed, and surgeons find the appendix is healthy. However, with the advent of laparoscopy, misdiagnosis is becoming a thing of the past.
What Happens During An Appendicectomy ?
Before the operation the patient will be sedated with a tranquillizer and then given a general anaesthetic. The surgeon cleans the skin over the site of the appendix with an antiseptic solution and makes an incision through the skin, underlying layers of fat and the muscle, to expose the appendix.
The blood vessels leading to the appendix are tied off with sutures (stitches) and the inflamed organ is snipped off at its base. The base is buried in the wall of the intestine using a purse-string suture. A drain may be left in the wound temporarily to remove any pus and other fluids which collect. The surgeon then repairs each tissue layer until reaching the incision, which is closed with more sutures.
If a laparoscope is used, the surgeon is able to make smaller incisions in the skin and to dissect the appendix inside the body before removing it.
The operation is more complicated if the appendix ruptures and abscesses have formed. These must be drained, so tubes may be left in the surgical wound to allow the continued removal of pus and fluids after the incision is closed. Doses of antibiotics are given to resolve the peritonitis.
Postoperative Care in India
- Routine observation of heart rate, blood pressure and temperature
- Allow free fluids orally and full diet the next day
- DVT prophylaxis should be commenced immediately
- Two further doses of the antibiotic used on induction can be given postoperatively
