Appendectomy is what?

Treatment of appendicitis always involves the operation. Before the surgical intervention, the patient is prescribed preparatory measures: take tests, do x-rays and ultrasound, study anamnesis. Only after receiving the results of the examination proceed to appendectomy. There are several varieties of this operation. About them we will talk in more detail in today's article.

What is appendicitis?

This is an acute surgical disease, manifested by pain in the abdomen and symptoms of intoxication. It is characterized by an inflammation of the appendix of the appendix. In childhood, he takes an active part in local immunity. However, this function is lost with time. Worm-like process becomes useless formation. Therefore, its removal does not carry a negative effect on the body.

Appendicitis is usually diagnosed in young people. The causes of the development of the inflammatory process are still unknown. Physicians express various assumptions and hypotheses. With the apparent simplicity of the diagnosis, it is difficult to identify it at the initial stage. Pathology is often "masked" for other diseases, has an atypical course. Regardless of the reason for appendicitis, appendectomy is the only option for his treatment.

Indications for operation

Appendectomy refers to the category of interventions that are carried out in an emergency. In this case, the main indication for the operation is an inflammatory process in an acute form. Scheduled surgical intervention is prescribed in the case of an appendicular infiltrate. This pathology, in which the appendix merges with the intestine, gland or peritoneum. After it subsides (approximately 2-3 months after the onset of the disease) an operation is performed. If the symptoms of intoxication grow spontaneously, an abscess breaks with subsequent peritonitis, the patient needs emergency intervention.

Preparation for the procedure

The operation of appendectomy lasts no more than an hour. During the intervention, general or local anesthesia is used. The choice of a particular variant depends on the age of the patient, his condition and the presence of concomitant pathologies. For example, a general anesthesia is recommended for children and people with excess weight, as well as for mental illness or nervous overexcitation. Patients with a lean physique prefer local anesthesia. This category includes pregnant women, because general anesthesia negatively affects the fetus.

Appendectomy is an emergency operation. It does not involve enough time to prepare the patient. Therefore, before the intervention, a minimum number of examinations is prescribed: blood and urine tests, ultrasound, x-ray. To exclude the pathology of the appendages, women are advised to consult a gynecologist.

Immediately before the operation, a catheter is placed in the bladder, and the stomach is washed. With constipation an enema is shown. The entire preparatory stage lasts no more than 2 hours. After confirming the diagnosis, the doctor also determines the specific variant of the intervention. Today, this operation is possible in several ways (traditional, laparoscopic and transluminal).

Each of them will be described in detail below.

Traditional Appendectomy

Treatment of appendicitis in this way is divided into two parts. First, the doctor receives operative access, and then proceeds to the procedure for the induction of the cecum. Intervention lasts no more than one hour.

To access the inflamed process, the surgeon makes a cut on the skin in the right ileal region. Its length is usually 7 cm. The reference point is the McBurney point. After dissection of the skin and fat tissue the doctor penetrates directly into the abdominal cavity. Muscles move aside without cuts. The last obstacle is the peritoneum. It is also dissected between the clamps.

If the adhesions and fusion in the peritoneum are absent, the surgeon proceeds to excise the caecum with the vermiform appendage. Extraction of the appendix is possible in two ways: retrograde and antegrade. The latter option is most often used. In this case, a specialist bandages the vessels of the mesentery, applies a clamp to the base of the appendage, and afterwards sutures and cuts it. Retrograde appendectomy is carried out in a different sequence. First, the vermicular appendage is cut off, its stump is placed in the gut, the seams are superimposed. After this, the specialist gradually sips the mesentery vessels in stages, it is removed. The need for such an operation is due to the localization of the appendix in the retroperitoneal space or the presence of numerous adhesions.

Transluminal appendectomy

This is a minimally invasive operation. Access to the inflamed process is carried out by means of flexible tools that the doctor enters through natural openings on the body.

Intervention is possible in two ways: transvaginally or transgastrally. In the first case, the instruments are inserted through a small incision into the vagina, and in the second - in the wall of the stomach. This operation has many advantages. It is characterized by a relatively small rehabilitation period, rapid recovery and the absence of visible cosmetic defects. Unfortunately, such a procedure is not performed at every clinic and solely on a fee basis.

Laparoscopic appendectomy

This minimally invasive operation belongs to the category of sparing methods of therapy. It has the following advantages:

• Low traumatism;
• Absence of cosmetic defect;
• Fast recovery period;
• The possibility of using local anesthesia;
• A low probability of complications.

On the other hand, laparoscopic appendectomy has several disadvantages. For example, it requires the availability of expensive equipment, and the doctor must have appropriate knowledge. In particularly serious clinical cases, especially with peritonitis, it is inexpedient and even dangerous.

What are the key points of laparoscopic appendectomy? The course of the transaction includes:

1. Perform a small puncture in the navel. Through him, the doctor enters the laparoscope and examines the cavity from the inside.
2. In the pubic region and the right hypochondrium, several incisions are additionally made. They are necessary for the introduction of surgical instruments. The doctor grasps the appendix, bandages the blood vessels and cuts off the mesentery. After that, the process is removed from the body.
3. The specialist conducts sanation of the abdominal cavity, if necessary installs drainage.

Only in rare cases is accompanied by complications laparoscopic appendectomy. The course of the procedure is controlled by several doctors, so the cosmetic effect is determined by their efforts and skills.

Recovery period

During the rehabilitation, care for the wound plays a special role. Dressings are carried out in a day, and in the presence of installed drainage - daily.

Many patients complain of discomfort and even pain several hours after the intervention. Such symptoms are considered natural, they should not be frightened. In case of acute need, the doctor prescribes the patient analgesics.

Most patients during the recovery period prefer to observe strict bed rest, referring to weakness. It is not right. The earlier the patient starts moving, the less the risk of complications. Even a short walk through the ward or hospital allows the intestines to get into work faster.

Contraindications

This operation has practically no contraindications. However, for the safe conduct of the procedure, the doctor must evaluate the patient's condition. For example, laparoscopic appendectomy is not recommended in the following cases:

1. More than 24 hours have passed since the first signs of the disease appeared.
2. The presence of concomitant inflammatory processes in the organs of the digestive tract.
3. Diagnosed earlier serious diseases of the cardiac or pulmonary system.

In these cases, laparoscopic appendectomy technique is replaced by the traditional one.

Possible complications

The appearance of complications after the intervention is possible, so the patient needs constant monitoring. The operation itself proceeds safely, and the negative consequences are most often due to unusual localization of the process in the abdominal cavity.

What complications of appendectomy can patients expect? The most common consequence of the operation is the suppuration of the suture. Every fifth patient has to face this problem. Also, it is possible to develop peritonitis, thromboembolism, adhesions. The most dangerous complication is sepsis, when the purulent inflammation becomes chronic.

Cost of the procedure and patient feedback

Appendectomy is an operation that is usually performed in emergency cases. If you do not provide medical care, a person can die. Therefore, talking about the cost of this kind of therapy is illogical. Traditional appendectomy is free of charge. The social status of the patient, his age and citizenship do not matter. This order is introduced in all modern states.

Doctors can save a person's life by making him an operation. However, follow-up and diagnosis often require additional costs. For example, a general analysis of blood or urine costs about 500 rubles. For consultation with a specialized specialist will have to give a little more than 1 thousand rubles. Costs after intervention related to the need to continue treatment are usually covered by insurance.

Appendectomy is an unplanned operation. Therefore, the opinions of patients about the treatment passed often vary. If the pathology was limited, and the medical care was provided in a high-quality and timely manner, the feedback would be positive. Especially good impression leaves after itself a laparoscopy. After all, just a few days after the intervention, the patient can return to normal life. Complicated forms of the disease are transferred much worse, and negative memories of patients remain forever.