Appendicectomy may be performed laparoscopically 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.
An inflamed appendix can be life-threatening, particularly if the patient is out of reach of medical care. Historical records show a number of appendectomies carried out by unskilled ad hoc surgeons, communicating with a base hospital by telephone or even telegraph.
To find the cause of unexplained abdominal pain, exploratory surgery is sometimes performed. If the cause of symptoms does not lie in the appendix, the surgeon will thoroughly check the other abdominal organs and remove the appendix anyway, to prevent problems in the future. Recent findings on the possible usefulness of the appendix has led to an abatement of this practice.
The two main surgical techniques include open and laparoscopic appendectomy. In open appendectomy, an incision is made through the skin, the underlying tissue and the abdominal wall in order to access the appendix.
Laparoscopic appendectomy involves making three small incisions in the abdomen, through which particular instruments are inserted. A gas is gently pumped into the abdominal cavity to separate the abdominal wall from the organs. This makes it easier to examine the appendix and internal organs. (However, a laparoscopic appendectomy may need to become open surgery if the appendix has ruptured.)
Once the appendix is accessed by either open or laparoscopic surgery, the blood vessels that supply it are clamped and the appendix cut and removed. In laparoscopic appendectomy, the appendix is removed through one of the small 'keyhole' incisions.
Immediately after the operation
After the operation, you can expect:
- Nurses will regularly record your temperature, blood pressure, pulse and respiration.
- Nurses will observe your wound and level of pain, and give you painkillers as ordered by your doctor.
- If there are no complications, you can get out of bed quite soon after the operation.
- Early movement is desirable, but caution is needed for climbing stairs so as not to strain the abdominal muscles.
- You should be able to eat about 24 hours or so after the operation.
- You should be able to leave hospital two to three days after an uncomplicated appendectomy.
- If you have external sutures (stitches), you usually have them removed after one week or so. Sometimes, surgeons use dissolvable sutures.
All surgery carries some degree of risk. One of the most common complications following appendectomy is infection. Around 20 per cent of people who have a ruptured appendix develop an abscess (ball of pus) within the abdominal cavity some two weeks or so after the appendectomy. These abscesses must be surgically drained. Another common type of infection following appendectomy is infection of the wound.
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