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Last updated: 11/24/2009
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.
The overall complication rate of appendectomy depends upon the status of the appendix at the time it is removed. If the appendix has not ruptured, the complication rate is only about 3%. However, if the appendix has ruptured, the complication rate rises to almost 59%. Wound infections do occur and are more common if the appendicitis was severe, far advanced, or ruptured. An abscess may also form in the abdomen as a complication of appendicitis.
Occasionally, an appendix will rupture prior to its removal, spilling its contents into the abdominal cavity. Peritonitis or a generalized infection in the abdomen will occur. Treatment of peritonitis as a result of a ruptured appendix includes removal of what remains of the appendix, insertion of drains (rubber tubes that promote the flow of infection inside the abdomen to outside of the body), and antibiotics. Fistula formation (an abnormal connection between the cecum and the skin) rarely occurs. It is only seen if the appendix has a broad attachment to the cecum and the appendicitis is far advanced, causing destruction of the cecum itself.
The complications associated with undiagnosed, misdiagnosised, or delayed diagnosis of appendicitis are very significant. This has led surgeons to perform an appendectomy any time that they feel appendicitis is the diagnosis. Most surgeons feel that in approximately 20% of their patients, a normal appendix will be removed. Rates much lower than this would seem to indicate that the diagnosis of appendicitis was being frequently missed.
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This video contains actual footage of an appendectomy. The procedure is being performed laparoscopically and shows what the surgeon sees through the small camera inserted into the body. This video may be difficult for some viewers since it shows surgery on actual human tissue.
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). (Illustration by GGS Inc.)
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An appendicectomy (or appendectomy) is the surgical removal of the vermiform appendix. This procedure is normally performed 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 treated non-operatively. In some cases the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix. This is a relative contraindication to surgery.
Appendicectomy 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 open surgery 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.
Other Information
Biliary colic is the presenting symptom in 80% of patients with gallstone disease who seek medical care; however, only 10-20% of all individuals with gallstones experience severe gallstone pain.
From: eMedicine
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