Introduction The appendix is a small fingerlike appendage about 10 cm (4 in) long, attached to the cecum just below the

ileocecal valve. No definite functions can be assigned to it in humans. The appendix fills with food and empties as regularly as does the cecum, of which it is small, so that it is prone to become obstructed and is particularly vulnerable to infection (appendicitis). Appendicitis is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity. About 7% of the population will have appendicitis at some time in their lives, males are affected more than females, and teenagers more than adults. It occurs most frequently between the age of 10 and 30. The disease is more prevalent in countries in which people consume a diet low in fiber and high in refined carbohydrates. The lower quadrant pain is usually accompanied by a low-grade fever, nausea, and often vomiting. Loss of appetite is common. In up to 50% of presenting cases, local tenderness is elicited at Mc Burneys point applied located at halfway between the umbilicus and the anterior spine of the Ilium. Rebound tenderness (ex. Production or intensification of pain when pressure is released) may be present. The extent of tenderness and muscle spasm and the existence of the constipation or diarrhea depend not so much on the severity of the appendiceal infection as on the location of the appendix. If the appendix curls around behind the cecum, pain and tenderness may be felt in the lumbar region. Rovsings sign maybe elicited by palpating the left lower quadrant. If the appendix has ruptured, the pain become more diffuse, abdominal distention develops as a result of paralytic ileus, and the patient condition become worsens. Constipation can also occur with an acute process such as appendicitis. Laxative administered in the instance may result in perforation of the in flared appendix. In general a laxative should never be given when a persons has fever, nausea or pain.

What is Appendectomy? Appendectomy is the surgical removal of the appendix. The appendix is a worm-shaped hollow pouch attached to the cecum, the beginning of the large intestine. Appendectomies are performed to treat appendicitis, an inflamed and infected appendix. Why is it done? Appendectomy is performed to prevent an inflamed appendix bursting and causing peritonitis (inflammation of the peritoneum, the lining of the abdominal cavity) or an abdominal abscess.

How is it done? The two methods of appendectomy are conventional appendectomy and minimally invasive surgery. In both types of operation, the appendix is identified, clamped, tied off at its base, and removed. If the appendix has burst, the infected area of the abdominal cavity is washed out with saline and drained via a tube inserted into one of the incisions. Antibiotic drugs may also be given to prevent peritonitis.

Indication

Patients with appendicitis always need urgent referral and prompt treatment. Consider an appendectomy for patients with a history of persistent abdominal pain, fever, and clinical signs of localized or diffuse peritonitis, especially if leukocytosis is present.

Contraindication

No contraindications to appendectomy are known for patients with suspected appendicitis, except in the case of a patient with a long history of symptoms and signs of a large phlegmon. If a periappendiceal abscess or phlegmon exists secondary to appendiceal perforation or rupture, some clinicians may choose a conservative approach with broad-spectrum antibiotics and percutaneous drainage followed by appendectomy later (interval appendectomy).

Risks

Certain risks are present when any operation is performed under general anesthesia and the abdominal cavity is opened. Pneumonia and collapse of the small airways (atelectasis) often occurs. Patients who smoke are at a greater risk for developing these complications. Thrombophlebitis, or inflammation of the veins, is rare but can occur if the patient requires prolonged bed rest. Bleeding can occur but rarely is a blood transfusion required. Adhesions (abnormal connections to abdominal organs by thin fibrous tissue) are a known complication of any abdominal surgery such as appendectomy. These adhesions can lead to intestinal obstruction that prevents the normal flow of intestinal contents. Hernia is a complication of any incision. However, they are rarely seen after appendectomy because the abdominal wall is very strong in the area of the standard appendectomy incision. Possible Complication

As with any other surgery, there are certain risks involved in appendectomy as well. Wounds, abscesses, bleeding and infections are the common appendectomy complications. Frequency or risks involved in appendectomy depend on the state of the appendix at the time of its removal. Sometimes, the appendix might rupture during the surgery and as a result, pus might spill over the abdominal cavity. This can cause peritonitis or a generalized infection in the

abdomen. Injury to the surrounding organs is one of the common laparoscopic or open appendectomy complications. Post appendectomy complications could also include paralytic ileus. When the surgeon performs appendectomy, it might disturb the bowel movement and as a result, it might come to a standstill. The bowel might become swollen or distended due to fluid and gas.

Position Place the patient supine and tuck his or her right arm for the duration of the procedure. The surgeon should stand on the patient's right, and the assistant surgeon should stand on the patient's left.

Incision site

McBurney incision- small incision that runs diagonally on the abdominal wall in the right lower quadrant (i.e., parallel to the edge of the external oblique muscle or in the direction running from the hip bone to the pubic bone.) Rocky-Davis incision- small incision that runs horizontally on the abdominal wall in the right lower quadrant Midline incision- this is sometimes done is the patient is obese or if the surgeon is anticipating the need for a formal resection of the terminal ileum and cecum (i.e., if the appendix has ruptured at the base)

When the surgeon performs a laparoscopic appendectomy, four incisions, each about 1 in (2.5 cm) in length, are made. One incision is near the umbilicus, or navel, and one is between the

umbilicus and the pubis. Two other incisions are smaller and are on the right side of the lower abdomen. The surgeon then passes a camera and special instruments through these incisions. With the aid of this equipment, the surgeon visually examines the abdominal organs and identifies the appendix. The appendix is then freed from all of its attachments and removed. The place where the appendix was formerly attached, the cecum, is stitched. The appendix is removed through one of the incisions. The instruments are removed and then all of the incisions are closed.

To remove a diseased appendix, an incision is made in the patient's lower abdomen (A). Layers of muscle and tissue are cut, and large intestine, or colon, is visualized (B). The appendix is located (C), tied, and removed (D). The muscle and tissue layers are stitched (E). Instrumentation: Major Lap tray or minor tray

Internal stapling device (opt.) Supplies/Equipment: Basin set Blades- (1) #20, (1) #10 Needle counter E.S.U Suction Penrose drain (1/4 in. opt.) Culture tubes (aerobic/anaerobic) Solutions- Saline, water Sutures- Chromic 2.0, Silk Internal stapling instrument (opt.) Medication- surgeon Preference