Watch video about laparoscopic appendectomy surgery here for FREE! You'll see how doctors do with our appendix!.Appendicitis Updated Review
Review all aspect of appendicitis including symptoms, sign, investigation,treatment and surgery
Watch video about laparoscopic appendectomy surgery here for FREE! You'll see how doctors do with our appendix!.Open Appendectomy for Appendicitis
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.
Open versus Laparoscopic Appendectomy for Treatment of Appendicitis
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;
History of Appendicitis
The first descriptions of the appendix date to the sixteenth centuryAlthough first sketched in the anatomic notebooks of Leonardo da Vinci around 1500, the appendix was not formally described until 1524 by da Capri and 1543 by Vesalius.Perhaps the first description of a case of appendicitis was by Fernel in 1554, in which a 7-year-old girl with diarrhea was treated with a large quince. Soon thereafter she developed severe abdominal pain and died. Autopsy showed that the quince had obstructed the appendiceal lumen, resulting in appendiceal necrosis and perforation. For the next few centuries, such cases of appendicitis were typically diagnosed at autopsy.
Amyand is credited with the first appendectomy in 1736, when he operated on a boy with an enterocutaneous fistula within an inguinal hernia.On exploration of the hernia sac, he discovered the appendix, which had been perforated by a pin resulting in a fecal fistula. As a result of his original description, an inguinal hernia containing the appendix carries Amyand’s eponym to this day.Nearly 150 years passed until Lawson Tait in London presented the first successful transabdominal appendectomy for gangrenous appendix in 1880. Less than a decade later, in 1886, Reginald Fitz of Harvard Medical School first described the natural history of the inflamed appendix, coining the term “appendicitis.”In 1889, Charles McBurney of the Columbia College of Physicians and Surgeons in New York presented his series of cases of surgically-treated appendicitis and in so doing described the anatomic landmark that now bears his name. McBurney’s point is the location of maximal tenderness “very exactly between an inch and a half and two inches from the anterior spinous process of the ileum on a straight line drawn from that process to the umbilicus.”In the 1890s, Sir Frederick Treves of London Hospital advocated conservative management of acute appendicitis followed by appendectomy after the infection had subsided; unfortunately, his youngest daughter developed perforated appendicitis and died from such treatment.
Numerous advances in the diagnosis and treatment of appendicitis have emerged in the past 125 years. Nonetheless, acute appendicitis continues to challenge surgeons to this day.
The first descriptions of the appendix date to the sixteenth centuryAlthough first sketched in the anatomic notebooks of Leonardo da Vinci around 1500, the appendix was not formally described until 1524 by da Capri and 1543 by Vesalius.Perhaps the first description of a case of appendicitis was by Fernel in 1554, in which a 7-year-old girl with diarrhea was treated with a large quince. Soon thereafter she developed severe abdominal pain and died. Autopsy showed that the quince had obstructed the appendiceal lumen, resulting in appendiceal necrosis and perforation. For the next few centuries, such cases of appendicitis were typically diagnosed at autopsy.
Treatment of appendicitis, Appendectomy
With few exceptions, the treatment of appendicitis is surgical (ie, appendectomy). The operation can be done open or laparoscopically. The results of clinical trials comparing the two methods show no clear-cut advantage of one method over the other, though patients treated laparoscopically return to work a few days earlier. A laparoscopic approach is desirable when the preoperative diagnosis is uncertain because the morbidity is less if the appendix is found to be uninflamed and an appendectomy is not done.
Prophylactic antibiotics are indicated preoperatively. A single-drug regimen, usually a cephalosporin, is as effective as more aggressive multiple-drug combinations. Routinely culturing abdominal fluid is of no practical value even when the appendix has perforated. The organisms obtained are the usual fecal flora.
