Acute appendicitis is the most common cause of abdominal pain among children and teenagers worldwide. They can be either acute or chronic. Acute appendicitis develops fast and can be removed using surgery. It can become severe, however, if not discovered and treated in time. Chronic appendicitis, on the other hand, develops slower and has less pronounced symptoms.
Acute appendicitis is caused by bacterial infections in the vermiform appendix, a tubular extension of the large intestine which functions as part of the digestive process. When the appendix is blocked by feces or it is squeezed by lymph nodes, it swells and usually doesn’t receive enough blood.
If open appendectomy is chosen for treat appendicitis, the surgeon must then decide on the location and type of incision. Prior to incision, a single dose of antibiotics should be administered, typically a second-generation cephalosporin.The appendicitis patient should be re-examined after the induction of general anesthesia, which enables deep palpation of the abdomen. If a mass representing the inflamed appendix can be palpated, the incision can be centered at that location. If no appendiceal mass is detected, the incision should be centered over McBurney’s point, one-third of the distance from the anterior superior iliac spine to the umbilicus. A curvilinear incision, now known as a McBurney’s incision, is made in a natural skin fold. It is important not to make the incision too medial or too lateral. An incision placed too medial opens onto the anterior rectus sheath, rather than the desired oblique muscles, while an incision placed too lateral may be lateral to the abdominal cavity.
Once the diagnosis of appendicitis is made, the surgeon must decide whether to perform an open (OA) or laparoscopic (LA) appendectomy. Numerous randomized controlled trials have compared these two methods for treat appendicitis, sometimes with conflicting results. Meta-analyses and systematic reviews have combined these studies to address the controversy (See table below). These meta-analyses have similar findings, which can be summarized in appendicitis surgery as follows:
(1) OA can be performed more quickly;
(2) LA patients have less postoperative pain and reduced narcotic requirements;
(3) there is a trend toward reduced length of stay with LA;
(4) LA patients have fewer wound infections;
(5) OA patients develop fewer intra-abdominal abscesses;
(6) LA patients return to work more quickly;
When the decision is made to perform an appendectomy for acute appendicitis, the patient should proceed to the operating room with little delay to minimize the chance of progression to perforation. Such occurrences are rare, however, as most cases of appendiceal perforation occur prior to surgical evaluation. Patients with appendicitis may be dehydrated from fever and poor oral intake, so intravenous fluids should be begun, and pulse, blood pressure, and urine output should be closely monitored. Markedly dehydrated patients may require a Foley catheter to ensure adequate urine output. Severe electrolyte abnormalities are uncommon with nonperforated appendicitis, as vomiting and fever have typically been present for 24 hours or less, but may be significant in cases of perforation. Any electrolyte deficiencies should be corrected prior to the induction of general anesthesia.