Appendicectomy

Appendicectomy

Introduction to Procedure

We know that undergoing any procedure is a scary experience.  We understand the worry and anxiousness that is associated with surgeries and procedures and aim to walk the road to recovery with you every step of the way. We put this information together using the very helpful handbook, ‘Handbook of Surgical Consent” from Rajesh Nair and David J. Holroyd.  We hope that the following information will answer all your questions and help you with the preparation phase for your procedure.

Description of procedure

Appendicectomy is the surgical removal of the vermiform appendix either due to clinically or radiologically suspected appendicitis or alternative pathology (i.e. tumour, mucocele etc).  The operation is performed under general anaesthesia with the patient in the supine position.  Both open and laparoscopic appendicectomy are acceptable, local practice may influence the surgeon’s decision.

Operative techniques

Open: A Gridiron or Lanz incision is made in the right iliac fossa. The layers are divided and the peritoneum is opened. The peritoneal cavity is entered and the appendix is identified, ligated, and excised. If the appendix has perforated, a washout is performed. The peritoneum is closed and the layers are closed with absorbable sutures.

Laparoscopic: In general, three or four small port incisions are made in the abdominal wall, the ports and camera are inserted following the introduction of a Pneumoperitoneum. The appendix is identified, ligated, and removed. The port sites are subsequently closed.

If an intra-abdominal mass is found (commonly following a perforated appendix) the decision may be made to manage this with antibiotics. Some surgeons may elect to subsequently perform an interval appendicectomy.

If the appendix is found to be macroscopically normal and the operation is performed open, it is best practice to perform the appendicectomy for two reasons: the first is that the appendix may be microscopically inflamed and the second being if a patient is noted to have either a Gridiron or Lanz incision it is assumed (rightly or wrongly) that they have previously undergone appendicectomy.

Once the operation has been performed, the appendix will be sent to the histopathology lab for examination.

Additional procedures that may become necessary
  • Conversion to open procedure (from laparoscopic) or laparotomy.
  • Need for alternative procedure.
Benefits
  • Diagnostic: Asses the size and extent of abscess and whether there is communication with the rectal mucosa in the form of a fistula-in-ano.
  • Therapeutic: Resolve sepsis, prevent fistula formation.
Alternative procedures/conservative measures
  • Medical: Antibiotic therapy is often used in conjunction with incision and drainage, and this may help with systemic sepsis.  The abscess cavity does, however, need to be drained surgically or allowed to discharge spontaneously to allow for evacuation of pus from a septic focus.
Serious/frequently occurring risks
  • Bleeding, infection, damage to sphincter mechanism, potential for faecal incontinence, fistula-in-ano formation, recurrence, urinary retention Even with incision and drainage: up to 66% may develop a fistula-in-ano later in life and up to 35% present at the time of incision and drainage.
Blood transfusion necessary
  • Group and save: The process of determining the patient’s ABO blood group and screening serum for the presence of antibodies to common red cell antigens that can cause transfusion reactions.
Type of anaesthesia/sedation
  • General anaesthesia.
  • Regional anaesthesia (Spinal/epidural).
Follow-up or need for further procedure
  • Regular dressing changes and packing of wound.
  • Occasionally a course of oral or intravenous antibiotics will be given.
  • Follow-up is necessary in cases where fistulas have been identified with subsequent examination under anaesthesia and fistula surgery.

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