Surgery using laparoscopy today is used much more often than classical abdominal methods. The advantages of this method are much greater than the disadvantages. In recent years, it has been used for appendicitis. It is safe to say that the removal of appendicitis by the laparoscopic method has long become the gold standard of treatment. The method was used to remove appendicitis for the first time about 30 years ago. In general, inflammation of the appendix in surgery is perhaps the most common pathology. Often it is with him that the training of interns-interns begins. The value of this method in its functionality is that it can be used both in diagnostics and in treatment.
On abdominal organs, laparoscopy enables the surgeon to study in detail the condition of all internal organs and accurately find the site of inflammation. The duration of the operation itself is reduced.
Removal of appendicitis by the laparoscopic method does not mean the exclusion of classical sections in general, any of the methods has pros and cons.
Cons of the classic abdominal incision
The disadvantages of abdominal operations include:
- long preservation of postoperative pain;
- increased invasiveness;
- long recovery period;
- long duration of suture healing;
- complications - 8%.
In the presence of all technical conditions, laparoscopy becomes, of course, preferable.
When is laparoscopy indicated?
Laparoscopy is indicated for the following pathologies:
- acute appendicitis;
- the presence of chronic inflammation with severe pain;
- mucocele;
- cysts;
- parasite infestation; benign tumors of the abdominal cavity;
- carcinomas.
If there is a complication in the form of peritonitis, abscess - abdominal surgery is performed. In addition, if the doctor did not have enough experience during laparoscopy, or technical errors were made, they switch to the classical method. But a surgeon with experience can perform an appendectomy laparoscopically and with a complicated form.
In Russia, appendicitis is removed by a laparoscopic method not as often as abroad. But the reasons for this are more subjective. These include:
- depth perception is distorted;
- tactile sensation is practically absent, which complicates the work of the surgeon;
- it is not always possible to calculate the strength of an application to instruments that are manipulated in internal organs;
- little space to control the operation of tools;
- the process of cutting tissues is difficult when the tool moves in the opposite direction from the hand.
Objective reasons are also not excluded:
- there is no sufficient theoretical basis;
- the method is considered to be of increased complexity for universal use;
- and, finally, not everywhere there is the necessary equipment.
Recovery after laparoscopic surgery
The recovery period when removing appendicitis by the laparoscopic method is short. Exclusion of movements is completely prohibited for only a few hours. By evening, the patient can already sit in bed.
In the morning, the patient is allowed to walk to the dressing room on his own. But you do not need to engage in sprinting, because the body will fully recover only after 2 months. During this time, complete healing of the cut intestines occurs. Categorically it is not supposed to lift and wear even small weights; only within 1-1.5 kg. Any efforts leading to tension and increased intra-abdominal pressure are excluded.
Statement after surgery
With the method of laparoscopy, it is carried out already for 3-4 days. On the second day after surgery, the drainage is removed. During inpatient stay, infusion therapy and antibacterial therapy are mandatory to exclude complications.
Some patients may experience pain in places of punctures for 2-3 days, then analgesics are prescribed. Removal of sutures is carried out on the 7-10th day, more often in the clinic at the place of residence.
Due to small punctures, this procedure is almost not felt. It is possible to use self-absorbable seams.
Diet during recovery
On the first day, food is excluded; drinking is also desirable. The next day, only drinking is allowed.
In the following days, the food should be liquid - porridge - “daub” and soup puree. Allowed products that do not interfere with gastrointestinal motility. Oatmeal jelly is very useful, giving a mild effect of enveloping the mucosa.
Of course, we are not talking about alcohol. Light quality drinks are allowed only after 2 months. Cooking only in a steam bath. This food lasts a month. Completely excluded:
- spicy spices and mayonnaise;
- cabbage and legumes;
- bakery products;
- smoked meats.
You can have any drinks, but only home-made.
How to speed up the rehabilitation process
The recovery period after surgery using the laparoscopic method for the removal of appendicitis is quite possible to reduce the light, but constant physical activity. By themselves, they will accelerate healing and become the prevention of many complications. The beginning of such loads is ordinary walks. Recovery after the laparoscopic method of removing appendicitis is shortened so that the patient may well get to work after 7-10 days.
Pros of Laparoscopy
The advantages of this method of operable intervention include:
- excellent cosmetic result;
- the percentage of adhesions is lower;
- the operation injures organs less;
- shortened rehabilitation and recovery with the laparoscopic method of appendicitis removal;
- obtaining the possibility of a detailed examination of the internal organs and, if necessary, conducting other operations without additional incisions;
- lower consumption of drugs and, consequently, economic benefits.
Cons of laparoscopy
Among the shortcomings for today, the following can be distinguished:
- the need for additional staff training;
- very expensive equipment;
- using the method is not always possible.
Today, groups of patients who need laparoscopy are highlighted. For example, if the diagnosis is unclear or for women of childbearing age who are planning a birth in which the gynecological problem is similar to the clinic of an acute abdomen.
Fact! Appendectomy without proper justification is performed in 47% of cases, in the future it will give adhesions and secondary infertility.
Also, laparoscopy is performed on the patient at his request (here it is already necessary to take into account not only all the pros and cons, but also the qualifications of the surgeon), women with a preference for the cosmetic effect, with diabetes and obesity, when the risk of complications is increased, and children to prevent the risk of occurrence adhesions.
Contraindications to laparoscopy
They are similar to any other operations:
- severe renal and hepatic diseases;
- CVD in decompensation;
- pregnancy after 26 weeks;
- bleeding disorders.
By the way, gestation is a relative contraindication, because there have been no cases with a negative effect on the fetus of the injected air during laparoscopy in the abdominal cavity.
Relative contraindications can also include:
- peritonitis;
- severe obesity;
- age after 60 years;
- atypical location of the appendix.
Local contraindications:
- the formation of inflammatory infiltrate around the process;
- commissures.
The abscessing periappendicular process can lead to rupture when air is introduced into the abdominal cavity. In addition, manipulations in this area can damage the great vessels and intestinal walls.
Preparation for surgery
Acute appendicitis is urgent, and no one will delay the time to prepare the patient.
Only a minimum of tests is done - blood and urine tests, abdominal ultrasound, blood on the RV, HIV, HBsAg, according to indications - ECG.
If there are doubts about the diagnosis, the operation may be postponed for observation in dynamics.
Laparoscopic surgery instrument kit
For the operation you will need:
- laparoscope;
- video camera and monitor;
- Light source;
- insufflator, Veress needle with which carbon dioxide is injected;
- electrosurgical equipment or laser for dissection of tissues and coagulation of blood vessels;
- irrigator-aspirator for removing blood, pus, fluid from the abdominal cavity.
In addition, you need to have scissors, tongs, clamps, four trocars of different diameters, devices for suturing or clips.
Operation Order
Apply general anesthesia. The patient lies on his back, the table is slightly tilted to the left to lead to the omentum and intestinal loops.
Then access to the right area is more free. With the help of a laparoscope, the surgeon will first fully examine all internal organs - the omentum, intestinal loops, gall bladder and liver, and the surface of the peritoneum; in women, the uterus, fallopian tube and ovary.
The inflamed process must be removed. To do this, it is crossed and the mesentery, coagulated or stitched vessels, the process is extracted through the trocar. Moreover, it should not be allowed to come into contact with other bodies. The process in a special container is sent for histology.
At this time, the doctor re-examines the abdominal cavity to rinse the surface of the peritoneum with antiseptics, for bleeding, aspiration of pathological impurities: pus, blood and fibrin.
All this is displayed through an irrigator. The drainage tube is inserted only according to indications: periappendicular abscess, peritonitis.
On average, the entire operation takes 30 minutes. If complications arise, the duration increases and the sequence may change. For example, with peritonitis, the effusion is first removed, and then they work with the appendix.
Antibiotics are also administered through the drainage tube. After the need for drainage disappears, it is removed, and there are no traces on the skin.
Rehabilitation period
The postoperative period of appendicitis removal by the laparoscopic method depends on the degree of inflammation. With inflammatory complications and sepsis, rehabilitation lasts more than a month. The risk of mortality has persisted all this time. To the question: how long to stay in the hospital with the removal of appendicitis by the laparoscopic method, you can answer exactly: in the absence of complications, discharge is made for 3-4 days.
What can help with rehabilitation
Many doctors insist on wearing a bandage - it allows you to create a normal position of the organs and does not allow complications to develop.
Physical activity - sports training is possible only at the end of scarring. The load is gradually increasing. Pool and sea - shown only with good wound healing after a month.
Price indicator
The cost of laparoscopic surgery is determined by the equipment used, the region of residence, the presence of complications.
For example, a typical abdominal operation costs 8000-12000 rubles, the price of laparoscopy starts from 18 thousand. Removing appendicitis using the laparoscopic method in Moscow will cost more than 20 thousand rubles. There are additional costs for treating drugs, staying in a bed, etc.
Complications of operations
Unforeseen consequences of appendicitis removal by laparoscopic method include:
- hardware malfunction;
- Tiflitis - burn of the cecum;
- an error with a puncture and damage to healthy organs;
- the appearance of emphysema - air bubbles under the skin;
- secondary infection of sutures;
- bleeding inside the abdominal cavity;
- hernia of the white line;
- hypotension.
If laparoscopy has already been performed on the patient, internal organs may be damaged due to the presence of adhesions.
Reviews
Reviews with the laparoscopic method of appendicitis removal and recovery after surgery, patients give only positive. This is due to minimal complications, a short rehabilitation period and its relative simplicity. There are no gross scars on the stomach, you can quickly return to work. There are also regrettable reviews on the removal of appendicitis by the laparoscopic method, but they mainly relate to the fact that not all clinics can offer laparotomy. In general, surgery is much preferable to a surgical incision.
Reviews on the removal of appendicitis by the laparoscopic method suggest that such operations simply save lives, despite the fact that the patient is very quickly discharged from the hospital.