Appendectomy

PROCEDURE OF THE DAY

Appendectomy

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 recognized 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.

Appendicectomy 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.

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 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 (ASIS) and the umbilicus; this represents the position of the base of the appendix (the position of the tip is variable). The various layers of the abdominal wall are then opened. 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.

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.


Emergency Appendectomy

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,radio or even telegraph. An emergency situation presented itself on the U.S.S. Henry W. Tucker (A destroyer named after Hospital Corpsman Henry W. Tucker, who risked his life to save his shipmates)in July 1972 when,in transit across the Pacific Ocean,an emergency apendectomy was undertaken by ship Hospital Corpsmen(Source:Robert Laity,SN,Hospital Corpsman striker and crew member of the Tucker,DD-875,July,1972).

OPEN Appendectomy


VIDEO