Appendectomy
General remarks
Classification
Acute appendicitis has 6 types:
- catarrhalis appendicitis; slightly red
- phlegmonous: moderate inflammation and ischaemia
- gangrenous: (partial) necrosis
- perforated
- appendicular mass
- appendicular abscess
Treatment
In case of an acute appendicitis, an appendectomy should be performed, either by laparotomy or by laparoscopy. In uncomplicated cases antibiotics could be both effective and safe, but still 20% of people have a recurrence within a year and require eventual appendectomy. Fertile females should get a laparoscopy, to exclude any gynaecologic pathology. An appendicular mass should be treatment with medicine and other conservative measures (e.g. rest, no enteral nutrition) Abscesses should be drained.
Antibiotics
All patients with an acute appendicitis should receive antibiotics. Normally the patient receives a single dose of antibiotics against gram-positive, gram-negative an anaerobes organisms. This treatment should be continued for 5 days in case of gangrenous and perforated appendicitis. In children a total of three days is sufficient.
Woundclosure
ll The skin can be closed entirely, and does not cause more wound-site infections compared to an approximating stitch. This also accounts for a perforated appendicitis.
Step by step
- Skin incision at McBurney's point
- Opening Scarpa's fascia
- Opening aponeurosis
- Atraumatic spreading of muscle fibers
- Identify and opening of peritoneum
- Identify cecum and appendix
- Deliver cecum and appendix
- Identify and ligate appendiceal artery
- Crush appendix at base
- Ligate and remove appendix at base
- If desired place a purse string suture around base of appendix
- Closing peritoneum
- Closing aponeurosis
- Skin closure
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