Treatment of appendicitis always involves an operation. Before surgery, the patient is prescribed preparatory measures: they take tests, take x-rays and ultrasound, study the anamnesis. Only after receiving the results of the examination proceed to appendectomy. There are several varieties of this operation. We will talk about them 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 inflammation of the vermiform appendix - the appendix. In childhood, he takes an active part in local immunity. However, over time, this function is lost. The appendix becomes a useless formation. Therefore, its removal does not have negative consequences for the body.
Appendicitis is usually diagnosed in young people. The reasons for the development of the inflammatory process are still unknown. Doctors express various assumptions and hypotheses. With the seeming simplicity of the diagnosis to identify it onthe initial stage is quite difficult. Pathology is often "disguised" as other diseases, has an atypical course. Regardless of the cause of appendicitis, appendectomy is the only treatment option.
Indications for surgery
Appendectomy is an emergency intervention. In this case, the main indication for surgery is an inflammatory process in an acute form. Planned surgical intervention is prescribed in case of appendicular infiltrate. This is a pathology in which the appendix merges with areas of the intestine, omentum or peritoneum. After it subsides (approximately 2-3 months from the onset of the disease), an operation is performed. If the symptoms of intoxication increase spontaneously, an abscess ruptures with subsequent peritonitis, the patient needs emergency intervention.
Preparing for the procedure
Appendectomy operation lasts no more than an hour. During the intervention, general or local anesthesia is used. The choice of a specific option depends on the age of the patient, his condition and the presence of concomitant pathologies. For example, children and overweight people, as well as mental illness or nervous overexcitation, are recommended general anesthesia. Patients with a lean physique prefer local anesthesia. Pregnant women also fall into this category, as general anesthesia adversely affects the fetus.
Appendectomy is an emergency operation. It doesn't take enough time to prepare.patient. Therefore, before the intervention, a minimum number of examinations is prescribed: blood and urine tests, ultrasound, x-rays. To exclude pathologies of the appendages, women are additionally recommended to consult a gynecologist.
Immediately before the operation, a catheter is inserted into the bladder, and the stomach is washed. With constipation, an enema is indicated. The entire preparatory stage lasts no more than 2 hours. After confirming the diagnosis, the doctor also determines the specific intervention option. Today, this operation is possible in several ways (traditional, laparoscopic and transluminal).
Each of them will be discussed in detail below.
Traditional Appendectomy
The treatment of appendicitis in this way is usually divided into two parts. First, the doctor receives prompt access, and then proceeds to the procedure for removing the caecum. The intervention lasts no more than one hour.
To gain access to the inflamed process, the surgeon makes an incision in the skin in the right iliac region. Its length is usually 7 cm. The McBurney point serves as a reference point. After dissection of the skin and fatty tissue, the doctor penetrates directly into the abdominal cavity. Muscles are moved to the sides without incisions. The last obstacle is the peritoneum. It is also cut between clamps.
If there are no adhesions and adhesions in the peritoneum, the surgeon proceeds to remove the caecum with the appendix. Extraction of the appendix is possible in two ways: retrograde and antegrade. Lastoption is used most often. In this case, the specialist bandages the vessels of the mesentery, puts a clamp on the base of the process, and then sutures and cuts it off. Retrograde appendectomy is performed in a different sequence. First, the appendix is cut off, its stump is placed in the intestine, sutures are applied. After that, the specialist gradually sutures the vessels of the mesentery, 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 through flexible instruments that the doctor inserts through natural openings on the body.
Intervention is possible in two ways: transvaginally or transgastrically. In the first case, the instruments are inserted through a small incision into the vagina, and in the second case, in the wall of the stomach. This operation has many advantages. It is characterized by a relatively short rehabilitation period, a quick recovery and the absence of visible cosmetic defects. Unfortunately, such a procedure is not performed in every clinic and exclusively on a paid basis.
Laparoscopic Appendectomy
This minimally invasive operation belongs to the category of sparing methods of therapy. It has the following benefits:
- low injury rate;
- no cosmetic defect;
- quick recovery period;
- opportunityuse of local anesthesia;
- low chance of complications.
On the other hand, laparoscopic appendectomy has several disadvantages. For example, it requires expensive equipment, and the doctor must have the appropriate knowledge. In especially serious clinical cases, especially with peritonitis, it is inappropriate and even dangerous.
What are the key points of a laparoscopic appendectomy? Operation progress includes:
- Performing a small puncture in the navel. Through it, the doctor inserts a laparoscope and examines the cavity from the inside.
- In the area of the pubis and right hypochondrium, several additional incisions are made. They are necessary for the introduction of surgical instruments. The doctor grabs the appendix, ties off the blood vessels, and cuts off the mesentery. After that, the appendix is removed from the body.
- The specialist performs the sanitation of the abdominal cavity, if necessary, installs drainage.
Only in rare cases, laparoscopic appendectomy is accompanied by complications. The course of the procedure is controlled by several doctors at once, so the cosmetic effect is determined by their efforts and skills.
Recovery period
Wound care is of particular importance during rehabilitation. Dressings are carried out every other day, and if there are installed drainages - daily.
Many patients complain of discomfort and even pain several hours after the intervention. Such symptoms are considerednatural, you should not be afraid of them. In case of urgent need, the doctor prescribes analgesics to the patient.
Most patients during the recovery period prefer to maintain strict bed rest, citing weakness. It is not right. The sooner the patient begins to move, the lower the risk of complications. Even a short walk around the ward or hospital allows the intestines to get to work faster.
Contraindications
This operation has practically no contraindications. However, for a safe procedure, the doctor must assess the patient's condition. For example, laparoscopic appendectomy is not recommended in the following cases:
- It has been more than 24 hours since the first signs of the illness appeared.
- The presence of concomitant inflammatory processes in the digestive tract.
- Previously diagnosed serious heart or lung disease.
In these cases, the laparoscopic appendectomy technique is replaced by the traditional one.
Possible Complications
The appearance of complications after the intervention is possible, so the patient requires constant monitoring. The operation itself proceeds safely, and the negative consequences are most often due to the unusual localization of the process in the abdominal cavity.
What complications of appendectomy can patients expect? The most common consequence of the operation is suppuration of the suture. Every fifth patient has to deal with such a problem. The development of peritonitis is also not excluded,thromboembolism, adhesive disease. The most dangerous complication is sepsis, when purulent inflammation becomes chronic.
Cost of the procedure and patient reviews
Appendectomy is an operation that is usually done in an emergency. If medical care is not provided, a person may die. Therefore, it is illogical to talk about the cost of this kind of therapy. Traditional appendectomy is free of charge. The social status of the patient, his age and citizenship do not matter. This order is established in all modern states.
Doctors can save a person's life by operating on him. However, follow-up and diagnosis often require additional costs. For example, a general blood or urine test costs about 500 rubles. For a consultation with a specialized specialist, you will have to pay a little more than 1 thousand rubles. Post-intervention costs associated with the need to continue treatment are usually covered by insurance.
Appendectomy is an unplanned operation. Therefore, patients' opinions about the therapy they have received often vary. If the pathology was limited, and medical care was provided in a quality and timely manner, the feedback will be positive. Laparoscopy leaves a particularly good impression. After all, just a few days after the intervention, the patient can return to normal life. Complicated forms of the disease are much worse tolerated, and negative memories in patients remain forever.
