Appendix surgery in Iran

Urinary Incontinence
March 20, 2019

Appendix surgery in Iran

Appendix surgery in Iran

Appendix surgery in Iran


Appendix is a small worm like structure attached to the cecum, the beginning of the colon, on the lower right side of abdomen. During first few years of life, appendix functions as part of the immune system, but after that it does not have any known function. Sudden inflammation of appendix is known as Appendicitis- and if you are able to recognize its symptoms, you can prevent serious appendicitis complications from occurring. The most serious complication of appendicitis is an infection of the lining of your abdominal cavity (peritonitis). This may occur if your appendix ruptures (perforates) and the contents of your intestines and infectious organisms invade the peritoneal cavity. Peritonitis is a medical emergency requiring immediate appendix treatment via surgery.

WHAT IS APPENDIX?


The appendix is a narrow, small, finger-shaped portion of the large intestine that is generally situated near junction of small and large intestine (Cecum) on lower right side of the abdomen.

WHAT CAUSES APPENDICITIS?


Appendicitis is a sudden inflammation of the appendix. Although the appendix does not seem to serve any purpose, but if left untreated, it can burst,or cause infection. It primarily occurs when the interior of the appendix becomes filled with something like mucus, bacteria, foreign materials, parasites or hard stools. This causes swelling in the appendix, thereafter leading to irritation and inflammation. Appendix may perforate, allowing stool, mucus, and other substances to leak through and get inside the abdomen causing localized abscess or generalised infection of abdomen (peritonitis).

 

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Procedure

Young nurses assist at an appendectomy 8b07788v.jpg

 

 

Surgeons perform a laparoscopic appendectomy.

In general terms, the procedure for an open appendectomy is:

  1. Antibiotics are given immediately if signs of actual sepsis are seen (in appendicitis, sepsis and bacteremia usually only occurs at some point after rupture, once peritonitis has begun), or if there is reasonable suspicion that the appendix has ruptured (e.g., on imaging) or if the onset of peritonitis- which will lead to full sepsis if not quickly treated- is suspected; otherwise, a single dose of prophylactic intravenous antibiotics is given immediately before 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 to the umbilicus), which represents the most common position of the base of the appendix.
  5. The various layers of the abdominal wall are opened. In order to preserve the integrity of abdominal wall, the external oblique aponeurosis is split along the line of its fibers, as is the internal oblique muscle. As the two run at right angles to each other, this reduces the risk of later incisional hernia.
  6. On entering the peritoneum, the appendix is identified, mobilized, and then ligated and divided at its base.
  7. Some surgeons choose to bury the stump of the appendix by inverting it so it points into the caecum.
  8. Each layer of the abdominal wall is then closed in turn.
  9. The skin may be closed with staples or stitches.
  10. The wound is dressed.
  11. The patient is brought to the recovery room.

Incisions

These incisions are placed for appendectomy:

  1. McBurney's incision, also known as grid iron incision
  2. Lanz incision
  3. Rutherford Morison incision
  4. Paramedian incision

 

Wound healing - ten days after a laparoscopic appendectomy

Over the past decade, the outcomes of laparoscopic appendectomies have compared favorably to those for open appendectomies because of decreased pain, fewer postoperative complications, shorter hospitalization, earlier mobilization, earlier return to work, and better cosmesis. However, despite these advantages, efforts are still being made to decrease abdominal incision and visible scars after laparoscopy. Recent research has led to the development of natural orifice transluminal endoscopic surgery (NOTES). However, numerous difficulties need to be overcome before a wider clinical application of NOTES is adopted, including complications such as the opening of hollow viscera, failed sutures, a lack of fully developed instrumentation, and the necessity of reliable cost-benefit analyses.

Many surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes in laparoscopic appendicectomy by using fewer and smaller ports. Kollmar et al. described moving laparoscopic incisions to hide them in the natural camouflages like the suprapubic hairline to improve cosmesis. Additionally, reports in the literature indicate that minilaparoscopic appendectomy using 2– or 3-mm or even smaller instruments along with one 12-mm port minimizes pain and improves cosmesis. More recently, studies by Ates et al. and Roberts et al. have described variants of an intracorporeal sling-based single-port laparoscopic appendectomy with good clinical results.

Also, a trend is increasing towards single-incision laparoscopic surgery (SILS), using a special multiport umbilical trocar. With SILS, a more conventional view of the field of surgery is seen compared to NOTES. The equipment used for SILS is familiar to surgeons already doing laparoscopic surgery. Most importantly, it is easy to convert SILS to conventional laparoscopy by adding a few trocars; this conversion to conventional laparoscopy is called 'port rescue'. SILS has been shown to be feasible, reasonably safe, and cosmetically advantageous, compared to standard laparoscopy. However, this newer technique involves specialized instruments and is more difficult to learn because of a loss of triangulation, clashing of instruments, crossing of instruments (cross triangulation), and a lack of maneuverability. Also, the additional problem of decreased exposure and the added financial burden of procuring special articulating or curved coaxial instruments exist. SILS is still evolving, being used successfully in many centres, but with some way to go before it becomes mainstream. This limits its widespread use, especially in rural or peripheral centres with limited resources.

Pregnancy

If appendicitis develops in a pregnant woman, an appendectomy is usually performed and should not harm the fetus. The risk of premature delivery is about 10%  The risk of fetal death in the perioperative period after an appendectomy for early acute appendicitis is 3 to 5%. The risk of fetal death is 20% in perforated appendicitis.

Recovery

 

Scar and bruise 2 days after operation

 

Scar 10 days after operation

A study from 2010 found that the average hospital stay for patients with appendicitis in the United States was 1.8 days. For patients with a perforated (ruptured) appendix, the average length of stay was 5.2 days.

Recovery time from the operation varies from person to person. Some take up to three weeks before being completely active; for others, it can be a matter of days. In the case of a laparoscopic operation, the patient has three stapled scars of about an inch (2.5 cm) in length, between the navel and pubic hair line. When an open appendectomy has been performed, the patient has a 2– to 3-inch (5–7.5 cm) scar, which will initially be heavily bruised.

 

10 common Questions about this surgery

1How long does an appendectomy surgery take?
Fast Facts about Laparoscopic Appendectomy Your child's surgery will be done under general anesthesia (an-es-THEEZ-ya), which means that he or she will be asleep during the surgery. Your child will most likely go home within 24 to 36 hours after the surgery.
2How long do you stay in the hospital after appendix surgery?
1 to 3 days You will stay in the hospital 1 to 3 days after the operation. In most cases you should be able to go back to your normal daily activities in 1 to 3 weeks. If your appendix ruptured or an abscess formed, you will need to stay at the hospital longer and it will take more time to recover.
3What are the side effects of having your appendix removed?
If the appendix bursts, it is likely that the individual will also have a high fever and severe pain in the abdominal area. Surgery is the most common treatment for appendicitis. ... When is an appendectomy needed? appetite loss. diarrhea. fever. frequent urination. nausea. painful urination. vomiting.
4Can you recover from appendicitis without surgery?
Antibiotics May Cure Appendicitis Without Surgery. ... Most appendicitis cases are uncomplicated, which simply means the organ hasn't ruptured, so they can be treated with antibiotics. Only when the appendix looks like it may burst immediately is an operation necessary.
5What kind of food causes appendicitis?
It is the most common disease which requires emergent surgery. The obstruction of appendix lumen is the main cause of appendicitis. Basically fecalith, lymphoid hyperplasia, seeds of fruits and vegetables, barium obturator, and tumors of large intestine and appendix can be found as etiology of acute appendicitis.
6Is an appendectomy a major surgery?
Appendicitis is one of the most common surgical problems. One out of every 2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall.
7How long is hospital stay for appendix removal?
Most people leave the hospital in 1 to 2 days after surgery. You can go back to your normal activities within 2 to 4 weeks after leaving the hospital. If you had laparoscopic surgery, you will likely recover quickly. Recovery is slower and more complicated if your appendix has broken open or an abscess has formed.
8What can you not do after appendix surgery?
You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Drink plenty of fluids (unless your doctor tells you not to). You may notice that your bowel movements are not regular right after your surgery.
9Is an appendectomy outpatient surgery?
Most appendix surgery (appendectomy) is performed as an urgent or emergency surgery. Some people may have already perforated their appendix and usually have surgery delayed and done as an outpatient procedure (elective surgery or interval appendectomy).
10Can appendicitis kill you?
When A Burst Appendix Doesn't Kill You. First, the warning label for this story: A perforated appendix can kill you. If you experience symptoms of appendicitis, particularly sharp pain in the lower right area of your abdomen, get prompt medical care.

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