The appendix is a thin tube that sits where the small and large intestines meet. If it gets infected, it can swell and eventually burst, which is a medical emergency.
An appendectomy is a surgery to remove an infected appendix. Historically, people believed you did not need your appendix, though researchers now think it may contribute to health. Its function remains unclear, but removing it is the most reliable way to treat appendicitis.
Appendectomy has been the standard treatment for appendicitis for over a century. People can live without an appendix, but interest in whether it contributes to good health has led to studies about whether appendectomy is really the best treatment.
One large study showed that antibiotics had comparable results for treating appendicitis, but three out of ten study participants treated with antibiotics ended up needing an appendectomy within 90 days. Many questions remain unanswered about using antibiotics for appendicitis, particularly regarding long-term efficacy. Appendectomy remains the preferred treatment option.
Open appendectomies are not as common as they once were, but they are the only option if the appendix has ruptured or if there is an abscess or fluid in the abdominal cavity. An open appendectomy is a major surgery requiring a large incision in the lower right abdomen.
A laparascopic appendectomy is more common in uncomplicated cases. Laparoscopic surgeries have many benefits over traditional surgeries. They are less invasive and have shorter recovery times.
Post-op infection is less likely since less of the body is open and exposed during the procedure, and the patient experiences less scarring. If complications arise or the infection is more extensive than initially thought, the surgeon may convert the procedure to an open appendectomy.
An incidental appendectomy is when the surgeon removes a healthy appendix during another abdominal surgery to prevent future problems. Doctors once thought that incidental appendectomies were beneficial in some situations, but they were always controversial.
Older studies showed that there was insufficient evidence to recommend them in children, but there may have been some benefit in patients younger than 35. Regardless, doctors generally do not recommend incidental appendectomies today.
Because appendectomy is emergency surgery, there are not too many contraindications. People who cannot tolerate laparoscopic surgery will need an open appendectomy. The surgery can also get complicated in patients who cannot tolerate general anesthesia or have blood clotting problems.
Surgeons generally do not do incidental appendectomies anymore, but they are usually avoided for people with Crohn's disease or those with unstable blood pressure or an inaccessible appendix.
Appendectomies, like other emergency surgeries, have no preparation requirements. Often, the person arrives at the emergency room complaining of severe abdominal pain and undergoes blood tests and imaging scans to confirm the diagnosis.
Appendectomies are usually done right away to avoid the appendix bursting. Regardless of the type of appendectomy, the patient will receive general anesthesia and get an IV in the operating room.
During an open appendectomy, the surgeon makes a cut or incision on the lower right part of the abdomen and then separates the abdominal muscles to gain access to the area. They tie off the appendix using stitches and remove it.
If the appendix has ruptured, the surgeon washes the abdomen with saline so the area is clean, to prevent infection. The surgeon then stitches closed the abdominal muscles and lining, inserts a drain to collect fluids outside the body, and closes the incision.
In a laparoscopic appendectomy, the surgeon makes small incisions in the belly button and around the abdomen. They insert a thin tube with a camera into the belly button incision, fill the abdominal cavity with carbon dioxide gas to make room for the procedure, and use special tools to remove the appendix through the small navel incision.
If complications arise or the infection is more extensive than initially thought, the surgeon may convert the procedure to an open appendectomy.
Recovery varies depending on whether the patient had open or laparoscopic surgery, how complicated the procedure was, and how the person tolerated the surgery. Most people recover completely within six weeks.
After surgery, patients must keep the incision clean, eat soft foods, slowly advance to a regular diet, and limit physical activity, especially after an open appendectomy.
The risks of an appendectomy include infection of the wound or abdomen, bleeding, and bowel obstruction.
People who have had an appendectomy should call their doctor if they are experiencing chills, fever, vomiting, or difficulty breathing. Report redness, bleeding, swelling, or fluid seeping from the incision. Patients must also monitor their bowel movements and call their doctor if they have none for two days or longer or have diarrhea for more than three days.
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