Treatment of appendicitis always implies an operation. Before surgery, the patient is prescribed preparatory measures: they take tests, do an X-ray and an ultrasound, and study the anamnesis. Only after receiving the results of the examination, they start an 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 appendix - 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 carry 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 make various assumptions and hypotheses. With the apparent simplicity of the diagnosis, it is quite difficult to identify it at the initial stage. Pathology is often "masked" by other diseases, has an atypical course. Regardless of the cause of appendicitis, appendectomy is the only treatment option.
Indications for surgery
Appendectomy refers to the category of interventions that are performed on an emergency basis. 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 vermiform appendix merges with parts of the intestine, omentum, or peritoneum. After it subsides (approximately 2-3 months after the onset of the disease), an operation is performed. If the symptoms of intoxication increase spontaneously, the abscess ruptures with subsequent peritonitis, the patient needs emergency intervention.
Preparation for the procedure
The 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, general anesthesia is recommended for children and overweight children, as well as for mental illness or nervous excitement. Patients with a thin physique are preferable to local anesthesia. Pregnant women fall into the same category, since general anesthesia negatively affects the fetus.
Appendectomy is an emergency operation. It does not imply enough time to prepare the patient. Therefore, the minimum number of examinations is prescribed before the intervention: blood and urine tests, ultrasound, x-rays. To exclude the pathologies of the appendages, women are additionally recommended to consult a gynecologist.
Right before the operation, a catheter is inserted into the bladder, gastric lavage is performed. With constipation, an enema is indicated. The entire preparatory phase lasts no more than 2 hours. After confirming the diagnosis, the doctor also determines the specific option for 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 with this method is usually divided into two parts. First, the doctor receives surgical access, and then proceeds to the procedure for removing the cecum. Intervention lasts no more than one hour.
To access the inflamed process, the surgeon makes an incision on the skin in the right iliac region. Its length is usually 7 cm. The landmark is the point of Mc Burney. After dissection of the skin and fatty tissue, the doctor penetrates directly into the abdominal cavity. Muscles move to the sides without incisions. The last obstacle is the peritoneum. It is also cut between the clamps.
If adhesions and adhesions in the peritoneum are absent, the surgeon proceeds to excrete the cecum with the appendix. There are two ways to extract the appendix: retrograde and antegrade. The latter option 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 vermiform process is cut off, its stump is placed in the intestine, stitches are applied. After this, 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 through flexible tools that the doctor inserts through the 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. Such an 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 gentle treatment methods. It has the following advantages:
- low invasiveness;
- lack of cosmetic defect;
- fast recovery period;
- the possibility of using local anesthesia;
- low probability of developing complications.
Laparoscopic appendectomy, on the other hand, has several drawbacks. For example, it requires the availability of expensive equipment, and the doctor must have the appropriate knowledge. In especially serious clinical cases, especially with peritonitis, it is impractical and even dangerous.
What are the key points of a laparoscopic appendectomy? The progress of the operation includes:
- Perform a small puncture in the navel. Through it, the doctor introduces a laparoscope and examines the cavity from the inside.
- In the area of the pubis and right hypochondrium, an additional few cuts are made. They are necessary for the introduction of surgical instruments. The doctor seizes the appendix, bandages the blood vessels and cuts off the mesentery. After this, the process is removed from the body.
- The specialist carries out sanitation of the abdominal cavity, if necessary, establishes drainage.
Only in rare cases is laparoscopic appendectomy accompanied by complications. The course of the procedure is monitored by several doctors at once, so the cosmetic effect is determined by their efforts and skills.
Recovery period
During rehabilitation, wound care is of particular importance. Dressings are carried out in a day, and in the presence of installed drains - daily.
Many patients complain of discomfort and even pain several hours after the intervention. Such symptoms are considered natural, they should not be scared. In case of urgent need, the doctor prescribes analgesics to the patient.
Most patients during the recovery period prefer to observe 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 involved in work faster.
Contraindications
This operation has virtually no contraindications. However, for a safe procedure, the doctor must assess the condition of the patient. For example, laparoscopic appendectomy is not recommended in the following cases:
- More than 24 hours have passed since the first signs of the disease appeared.
- The presence of concomitant inflammatory processes in the digestive tract.
- Previously diagnosed serious diseases of the cardiac or pulmonary systems.
In these cases, the laparoscopic technique of appendectomy is replaced by the traditional one.
Possible complications
The appearance of complications after the intervention is possible, therefore, the patient requires constant monitoring. The operation itself proceeds well, and the negative consequences are most often due to the unusual localization of the appendix in the abdominal cavity.
What complications of appendectomy can patients expect? The most common consequence of surgery is suppuration of the suture. Every fifth patient has to deal with such a problem. Also, the development of peritonitis, thromboembolism, adhesive disease is not excluded. 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, the person may die. Therefore, talking about the cost of this kind of therapy is illogical. Traditional appendectomy is free. The social status of the patient, his age and citizenship do not matter. Such an order is instituted in all modern states.
Doctors can save a person’s life by surgery. However, follow-up and diagnosis often require additional costs. For example, a general blood or urine test costs about 500 rubles. A consultation with a specialized specialist will have to pay a little more than 1 thousand rubles. Post-intervention costs associated with continuing treatment are usually covered by insurance.
Appendectomy is an unplanned operation. Therefore, patients' opinions about the treatment they have undergone often vary. If the pathology was of a limited nature, and medical care was provided in a quality and timely manner, reviews will be positive. Laparoscopy leaves a particularly good impression. Indeed, just a few days after the intervention, the patient can return to his usual life. Complicated forms of the disease are tolerated much worse, and negative memories in patients remain forever.