APPENDECTOMY

Anap p en d icectom y (orap p en d ectom y) is the surgical removal of the vermiform appendix. This

procedure is normallyperformed as an emergency procedure, when the patient is suffering from acute

appendicitis. In the absence of surgical facilities,intravenous antibiotics are used to delay or avoid the onset of

sepsis; it is now recognized that many cases will resolve when treatednon-operatively. In some cases the

appendicitis resolves completely; more often, an inflammatory mass forms around the appendix.This is a relative

contraindication to surgery.

Appendectomy may be performed laparoscopically (this is called minimally invasive surgery) or as an

open operation.Laparoscopy is often used if the diagnosis is in doubt, or if it is desirable to hide the scars in the

umbilicus or in the pubic hair line.Recovery may be a little quicker with laparoscopic surgery; the procedure is

more expensive and resource-intensive than opensurgery and generally takes a little longer, with the (low in most

patients) additional risks associated with pneumoperitoneum(inflating the abdomen with gas). Advanced pelvic

sepsis occasionally requires a lower midline laparotomy.

In general terms, the procedure for an appendicectomy is as follows.
1.Antibiotics are given immediately if there are signs of sepsis, otherwise a single dose of prophylactic intravenous
antibiotics is

given immediately prior to surgery.

2.General anaesthesia is induced, with endotracheal intubation and full muscle relaxation, and the patient is

positioned supine.

3.The abdomen is prepared and draped and is examined under anesthesia.

4.If a mass is present, the incision is made over the mass; otherwise, the incision is made over McBurney's point,
one third of
the way from the anterior superior iliac spine (ASIS) and the umbilicus; this represents the position of the base of
the
appendix (the position of the tip is variable).
5.The various layers of the abdominal wall are then opened.
6.The effort is always to preserve the integrity of abdominal wall. Therefore, the External Oblique Aponeurosis is
slitted along
its fiber, and the internal oblique muscle is split along its length, not cut. As the two run at right angles to each
other, this
 prevents later Incisional hernia.

7.On entering the peritoneum, the appendix is identified, mobilized and then ligated and divided at its base.

8.Some surgeons choose to bury the stump of the appendix by inverting it so it points into the caecum.

9.Each layer of the abdominal wall is then closed in turn.

10. The skin may be closed with staples or stitches.

11. The wound is dressed.

12. The patient will be brought to the recovery room.

APPENDICITIS

Appendicitis is inflammation of the appendix. It is thought that appendicitis begins when the opening from

the appendix into thececum becomes blocked. The blockage may be due to a build-up of thick mucus within the

appendix or to stool that enters theappendix from the cecum. The mucus or stool hardens, becomes rock-like, and

blocks the opening. This rock is called a fecalith(literally, a rock of stool). At other times, the lymphatic tissue in the

appendix may swell and block the appendix. Bacteria whichnormally are found within the appendix then begin to

invade (infect) the wall of the appendix. The body responds to the invasion by

mounting an attack on the bacteria, an attack called inflammation. (An alternative theory for the cause of

appendicitis is an initialrupture of the appendix followed by spread of bacteria outside the appendix.. The cause of

such a rupture is unclear, but it mayrelate to changes that occur in the lymphatic tissue that line the wall of the

appendix.)

If the inflammation and infection spread through the wall of the appendix, the appendix can rupture. After

rupture, infection canspread throughout the abdomen; however, it usually is confined to a small area surrounding

the appendix (forming a peri-appendiceal abscess).

Sometimes, the body is successful in containing ("healing") the appendicitis without surgical treatment if the

infection andaccompanying inflammation do not spread throughout the abdomen. The inflammation, pain and

symptoms may disappear. This isparticularly true in elderly patients and when antibiotics are used. The patients
then may come to the doctor long after the episodeof appendicitis with a lump or a mass in the right lower

abdomen that is due to the scarring that occurs during healing. This lumpmight raise the suspicion of cancer.
SIGNS AND SYMPTOMS

The main symptom of appendicitis is abdominal pain. The pain is at first diffuse and poorly localized, that

is, not confined toone spot. (Poorly localized pain is typical whenever a problem is confined to the small intestine

or colon, including the appendix.)The pain is so difficult to pinpoint that when asked to point to the area of the

pain, most people indicate the location of the painwith a circular motion of their hand around the central part of

their abdomen. A second, common, early symptom of appendicitis isloss of appetite which may progress to nausea

and even vomiting. Nausea and vomiting also may occur later due to intestinal obstruction.