Appendectomy (cont.)
How is appendicitis treated?
Once a diagnosis of appendicitis is made, an appendectomy usually is
performed. Antibiotics almost always are begun prior to surgery and as soon as
appendicitis is suspected.
There is a small group of patients in whom the inflammation and infection of
appendicitis remain mild and localized to a small area. The body is able not
only to contain the inflammation and infection but to resolve it as well. These
patients usually are not very ill and improve during several days of
observation. This type of appendicitis is called "confined
appendicitis" and may be treated with antibiotics alone. The appendix may
or may not be removed at a later time.
On occasion, a person may not see their doctor until
appendicitis with rupture has been present for many days or even weeks. In this
situation, an abscess usually has formed, and the appendiceal perforation may
have closed over. If the abscess is small, it initially can be treated with
antibiotics; however, the abscess usually requires drainage. A drain usually is
inserted with the aid of an ultrasound or CT scan that can determine the exact location of the
abscess. The appendix is removed several weeks or months after the abscess has
resolved. This is called an interval appendectomy and is done to prevent a
second attack of appendicitis.
How is an appendectomy done?
During an appendectomy, an incision two to three inches
in length is made through the skin and the layers of the abdominal wall in the area of the
appendix. The surgeon enters the abdomen and looks for the appendix, usually
located in the right lower abdomen. After examining the area around the appendix
to be certain that no additional problem is present, the appendix is removed.
This is done by freeing the appendix from its attachment to the abdomen and to
the colon, cutting the appendix from the colon, and sewing the over the hole in
the colon. If an abscess is present, the pus can be drained with drains (rubber
tubes) that go from the abscess and out through the skin. The abdominal incision
then is closed.
Newer techniques for removing the appendix involve the use of the
laparoscope. The laparoscope is a
thin telescope attached to a video camera that allows the surgeon to inspect the
inside of the abdomen through a small puncture wound (instead of a larger
incision). If appendicitis is found, the appendix can be removed with special
instruments that can be passed into the abdomen, just like the laparoscope,
through small puncture wounds. The benefits of the laparoscopic technique
include less post-operative pain (since much of the post-surgery pain comes from
incisions) and a speedier recovery. An additional advantage of laparoscopy is
that it allows the surgeon to look inside the abdomen to make a clear diagnosis
in cases in which the diagnosis of appendicitis is in doubt. For example,
laparoscopy is especially helpful in menstruating women in whom a rupture of an
ovarian cysts may mimic appendicitis.
If the appendix is not ruptured (perforated) at the time
of surgery, the patient generally is sent home from the hospital in one or two days. Patients
whose appendix has perforated generally are sicker than patients without
perforation. After surgery, their hospital stay often is prolonged (four to
seven days), particularly if peritonitis has occurred.
Intravenous antibiotics
are given in the hospital to fight infection and assist in resolving any
abscess.
Occasionally, the surgeon may find a normal-appearing appendix and no other
cause for the patient's problem. In this situation, the surgeon may remove the
appendix. The reasoning in these cases is that it is better to remove a
normal-appearing appendix than to miss and not treat appropriately an early or
mild case of appendicitis.
Next: What are the complications of appendectomy? »
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