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Appendicitis Surgery

The diseased appendix must be removed. There are two methods: laparoscopically, there are excellent results with a quick recovery. It can also be done with open technique if the patient wishes or has contraindications to laparoscopy.

What is appendicitis?

The inflammation of the cecal appendix, which is a structure of the gastrointestinal system attached to the first portion of the colon, causing moderate to severe pain, constant and if not resolved surgically, leads to severe complications. It is the most frequent surgical emergency worldwide.

Dr. Víctor Calao

Dr. Víctor Calao

Specialist in the timely diagnosis and immediate treatment of diseases of the gastrointestinal tract.

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These are some of the FAQs about Appendicitis Surgery

It starts with pain in the middle part of the abdomen, around the navel; there may be nausea and vomiting. Later this pain migrates or changes to the right lower quadrant and increases in intensity. It is constant and does not go away spontaneously. If the patient self-medicates with analgesics and antibiotics, there is a transitory improvement, but the pathological process described above continues. When the analgesic effect wears off, the pain returns with greater intensity, and the disease is probably already complicated.

In the vast majority of patients, there is a lack of hunger. There may be diarrhea and fever. The latter occurs in advanced cases. On physical examination, the patient is usually in the trigger position, i.e., bent to his right side, which is the only position he finds relief. There is increased heart rate, and there is intense pain on palpation of the right lower quadrant.

All require surgery; the affected appendix must be removed. There are two methods: laparoscopically, there are excellent results with a quick recovery. It can also be with open technique if the patient wishes or has contraindications to laparoscopy. The incisions in the laparoscopic appendectomy are one inside the umbilicus of 5 mm; another in the midline above the pubis; and one more in the lower left quadrant, on the line where the underwear is located.

In the open technique, a small incision is made in the right lower quadrant; it can be horizontal or oblique, and the abdominal cavity is reached just above the appendix. Another access route is through the midline below the umbilicus in cases where the patient has already had appendicitis for several days and arrives with data of sepsis or shock.

The use of antibiotics and analgesics reinforces treatment. These should be started before appendicitis surgery as soon as a surgeon has an accurate diagnosis of the disease. Intravenous hydration and analgesics are included.

The interrogation and physical examination performed by a surgeon are of great value. It is reinforced with laboratory studies and confirmed with imaging studies such as ultrasound or tomography. The latter is very useful in cases of women where the internal reproductive organs are close to the appendix and may be the cause of the pain.

It is produced by the occlusion of its internal canal, generally by a segment of fecal matter or also called fecalith. The appendix produces mucus that is discharged into the colon. When occluded, the production of mucus continues, increasing the pressure and distending the appendix. This is when the first symptoms begin with abdominal pain in the middle part.

If the obstruction persists, the appendix wall will become distended and thinner, which will block the venous drainage and arterial irrigation located at this point. The appendix becomes inflamed and causes pain in the right lower quadrant. The evolution will continue until the wall can no longer support anymore; it necroses and perforates, producing purulent material and a severe abdominal infection that leads to sepsis and death.

The embryonic stage has immunological tissue and participates in the development of immunoglobulins. In children, this tissue can become inflamed in viral infections and cause obstruction of the internal canal and lead to appendicitis.

In uncomplicated appendicitis surgery, the patient can leave the day after surgery and continue antibiotic and analgesic treatment at home. In a complicated disease where there was perforation, necrosis, abdominal abscess, the hospital stay can be 48 hours to several days.

General wound care includes washing with soap and water, keeping the wound dry, and covered with sterile gauze.

In laparoscopic surgery, recovery is immediate; in the first week, the patient can perform their daily activities. In open surgery, the patient must wait two weeks.  Diet should be low in fats and irritants. It is recommended not to eat cookies, bread, or simple sugars for two weeks due to the formation of gases and the distension of the intestines. This causes discomfort and mild pain.

The risks and complications will depend on the degree of affectation of the patient. Complicated appendicitis may involve neighboring organs such as the colon, small intestine, ovaries, etc. If any of them is affected, it may result in resection of that segment. That is why there is an excellent need for abdominal pain to be checked by a surgeon.

Other risks or possible complications are the formations of abscesses that occur after perforated appendicitis. The appendix has millions of bacteria in its interior, similar to the colon, and when it ruptures, they are released into the abdomen or are introduced into the incision site. Inside the abdomen, they can cause pus formation, but with the placement of proper drainage, it will be removed from the cavity, and there will be no significant problem. Bacteria that escape the incision site lodge in the fatty tissue beneath the skin and cause wound infection. It will manifest with a red, oozing, painful wound. Treatment is the removal of stitches and washing with soap and water.
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