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.
Appendectomy was one of the first intra-abdominal operations performed, and appendicitis has long been a surgically treated disease. Rare descriptions of nonsurgical management dot the surgical literature, however. Treves was an advocate of early nonoperative management of acute appendicitis, even prior to the advent of antibiotics. In the post-antibiotic era, Coldrey presented his retrospective series of 471 patients with appendicitis treated with antibiotics. This treatment failed in at least 57 patients, with 48 requiring appendectomy and 9 requiring drainage of an appendiceal abscess. Only one randomized controlled trial, performed by Eriksson and associates, addresses this issue. Their results show a high rate of recurrence of appendicitis treated nonsurgically. The authors randomized 40 adults with presumed appendicitis to appendectomy or 10 days of intravenous and oral antibiotics. Eight (40%) of the 20 patients in the antibiotic group required appendectomy within 1 year: one patient for perforation within 12 hours of randomization, and another 7 for recurrent appendicitis (one of whom had perforation). Based on the high rate of failure with antibiotics alone, nonoperative management of acute appendicitis cannot be recommended. Antibiotic treatment may be a useful temporizing measure, however, in environments with no surgical capabilities such as in space flight and submarine travel.
We utilize a three-port technique, with one umbilical and one suprapubic port in order to perform an appendicitis surgery. Although the third port can be placed in either the left or right lower quadrant, we prefer the left lower quadrant. This follows the laparoscopic principle of triangulation, such that the port locations direct the camera and instruments toward the right lower quadrant for optimal visualization of the appendicitis.
It is compulsatory to accept a surgical action anon the analysis of astute appendicitis is established. The operation is accepted as: appendectomy.
It is a accepted action and a accepted operation in the world. Laparoscopic is performed in the appropriate lower abdomen, if the appendicitis is apprehensible the accommodating is able to go home in 24-48 hours from the operation.
If appendicitis was doubtable and during surgical action the surgeon acquisition that the addendum is not inflammed, than the surgeon will abolish it anyhow and attending for added causes of accessible affliction in the abdomen. Recognizing astute appendicitis is not a difficult amount as continued as you apperceive its symptoms.