Surgery in Treatment of Appendicitis

Surgery is the main treatment of appendicitis. The surgical procedure is done for removal of appendix and known as appendicectomy. These days, laparoscopic (performed using an instrument called laparoscope) appendicectomy (removal of appendix) is done more frequently than traditional open surgical procedure to remove inflamed appendix. Laparoscopic appendicectomy is performed via three small incisions with a camera to visualize the inflamed appendix and remove it and suture the wound after removal of inflamed appendix via the three small incisions. If during laparoscopic appendicectomy, it is seen that there is rupture, abscess or adhesions, the surgical procedure should than be converted to open surgery and explored the abdomen and drained if required. In open appendicectomy, the incision is centered on the area of maximum tenderness at right lower quadrant of abdomen, known as McBurney’s point and a gridiron diagonal incision is most commonly used.

There is controversy, whether to perform emergency appendicectomy (performed within 6 hours of admission to hospital) or an urgent surgery (performed more than 6 hours after admission to hospital). But several studies show that there is no significant difference in outcome (risk of perforation, complications) of surgery, whether performed as emergency or as urgent. At present best approach seems to start antibiotic therapy and delay appendicectomy till the next day, as there are several other studies done, which show that emergency surgery performed at night have higher risk of complications due to availability of less staff and tiredness of the surgeons and other supporting staffs.

Disadvantages of laparoscopic appendicectomy:

There are several advantages of laparoscopic appendicectomy over open appendicectomy although there are also some disadvantages with it, e.g. the incidence of intraabdominal abscesses is higher with laparoscopic appendicectomy and the duration of surgical procedure is little longer in compare to open method.

Advantages of laparoscopic appendicectomy:

The advantages of laparoscopic appendicectomy are shorter duration of hospital stay, earlier return to normal activity (work, and sport activities) etc. Although the operation cost of laparoscopic appendicectomy is higher than normal open surgical procedure, the costs outside hospital are lowered. For the above advantages of laparoscopic appendicectomy the young female, obese, and employed patients benefit most from the procedure.

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