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An appendectomy is the surgical removal of a patientís appendix, a small tube attached to the colon. Most appendectomies are performed to treat an inflamed appendix (appendicitis). Left untreated, appendicitis can cause the appendix to rupture. This, in turn, may result in a potentially life-threatening infection of the inner lining (peritoneum) of the abdomen called peritonitis.
An appendectomy is almost always performed as an emergency treatment. Most people are unaware they have appendicitis until the symptoms become severe. Symptoms of appendicitis include pain in the lower right abdomen, fever, loss of appetite, nausea and vomiting.
There are two major types of appendectomy procedures: traditional open surgery and laparoscopy. For both, patients are given general anesthesia and are not awake during the procedure. Traditional open surgery involves making an incision in the patientís lower right abdomen and removing the appendix using surgical instruments. This technique is commonly used, particularly when a patientís appendix has already ruptured.
Open appendectomy is the traditional method and the standard treatment for appendicitis. The surgeon makes an incision in the lower right abdomen, pulls the appendix through the incision, ties it off at its base, and removes it. Care is taken to avoid spilling purulent material (pus) from the appendix while it is being removed. The incision is then sutured.
If the appendix has perforated (ruptured), the surgeon cleans the pus out of the abdomen with a warm saline solution to reduce the risk for infection. A drain may be inserted through the incision to allow the pus to drain from the abdomen. In this case, the skin is not sutured, but left open and packed with sterile gauze. The gauze and drain remain in place until the pus is completely drained and there is no sign of infection.
If the abdomen is so inflamed that the surgeon cannot see the appendix, the infection is drained and treated with antibiotics, and then the appendix is removed.
Requires just a few tiny incisions into the abdomen. A thin tube with a light and camera called a laparoscope is inserted into one of the incisions. The surgeon uses a monitor to watch the image of the appendix provided by the laparoscope and is able to remove the appendix through one of the incisions with minimum scarring.
Patients who have traditional open surgery usually spend one to three days in the hospital, whereas those who undergo laparoscopy are likely to be discharged from the hospital the same day of the procedure. Full recovery takes several weeks. Most patients do not have to make diet, exercise or other lifestyle changes following an appendectomy.
In rare cases, people who have undergone an appendectomy can experience ďstump appendicitis,Ē inflammation of the tiny part of the appendix that remains after surgery. In such cases, a second surgery may be needed to remove the remainder of the appendix. Leaving a stump less than 3 millimeters long in the original surgery may prevent stump appendicitis
Modern surgery is possible because of the development of safe and effective anesthesia. Without the ability to eliminate pain, most surgical procedures could not be performed.
There are three main types of anesthesia: local, regional, and general. The type of anesthesia used for a surgical procedure is determined by several factors:
- Type and length of the surgery
- Patient health
- Preference of the patient and physician
Local anesthesia blocks the nerves in a small, specific area of the body. For example, if a surgical procedure is performed on the right hand, a local anesthetic is used to numb that hand without affecting any other part of the body.
This type of anesthesia is generally used for minor surgeries (e.g., breast biopsies, vasectomies) and to stitch small wounds. It is usually administered by injection, which can be painful. However, the discomfort only lasts for a brief moment, and the anesthesia usually takes effect very quickly.
Sometimes local anesthesia is applied topically, as a spray or a cream. Cocaine is used medically as a sprayed anesthetic to numb the inside of the nose and throat. For the removal of a growth on the surface of the skin, an anesthetic cream can be applied to numb the area.
In minimally invasive procedures that can be completed in a few minutes, an injection of local anesthesia is all that is used. More involved operations require sedation with the anesthesia to make the patient more comfortable and the injection more tolerable. Sedatives relax the patient and induce drowsiness, but they do not put patients into a deep sleep. They are usually administered by injection or through an intravenous (IV), but can be given orally or by rectal suppository, particularly in children.
Regional anesthesia numbs a large area, or region, of the body and is used for more extensive and invasive surgery. Regional anesthesia is often used for procedures involving the lower part of the body, such as caesarian sections, prostate surgery, and operations on the legs. For example, if regional anesthesia is used for prostate surgery, the patient is numb from his navel to his toes. Some patients feel pressure or tugging during surgery performed under regional anesthesia.
The most common types of regional anesthesia are spinals and epidurals. Spinal anesthesia is injected into the spinal fluid with a special needle that penetrates the spinal column through the back. There may be some discomfort involved with the injection, but it passes as the anesthetic takes effect.
Epidural anesthesia is injected into an area outside the spinal column called the epidural space. Sometimes a small tube or catheter is inserted into the epidural space, which allows the anesthesiologist to administer more medication as needed. Epidurals are often used when long-term pain relief is needed, such as during childbirth.
Sedatives are commonly used with regional anesthesia and are generally administered intravenously.
General anesthesia renders the patient completely unconscious and with no memory of the surgical procedure upon awakening. Because it carries a higher risk for complications than other types of anesthesia, general anesthesia is used primarily for procedures that cannot be done utilizing other methods and for patients who prefer to be asleep during surgery.
General anesthesia is given intravenously or inhaled through a breathing mask, and sometimes both methods are used. Sedation may also be given before the patient is taken into the operating room.
Once the anesthesia has taken effect, patients need assistance breathing. Several devices are used. One is a piece of curved, hollow plastic called an oral airway. Another is a mask that fits over the nose and mouth. The most sophisticated device, a long plastic tube called an endotracheal tube, is placed in the patientís mouth (less frequently the nose) and is gently extended into the trachea, or windpipe. The trachea connects the mouth with the lungs. The endotracheal tube is used when the surgery is lengthy or involved, and the patient receives a large amount of anesthesia. The endotracheal tube is one of the safest and most reliable means of assuring adequate breathing with general anesthesia.
Patients are closely monitored by the anesthesiologist throughout the surgery. Heart rate, blood pressure, and blood oxygen levels are continuously recorded. The amount of anesthesia received is carefully controlled and adjusted for the duration of the procedure.
Complications Of Appendectomy
The most common complication is bacterial super-infection of the wound. It is easy to diagnose bacterial infection because the wound is healing much slower. Redness and tenderness can be seen on the place of incision. In such cases a surgeon sometimes does not close the wound. He leaves it open so he can treat it with antibiotics more easily !
Another possible complication of appendectomy is an abscess. Abscess is a collection of pus in the area of the appendix. It too can be treated with strong antibiotics and surgical excision.
Risks for any anesthesia include the following:
Risks for any surgery include the following:
- Reactions to medications
- Problems breathing
Additional risks with an appendectomy with ruptured appendix include the following:
- Longer hospital stays
- Side effects from medications
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