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The appendix is a small, finger-shaped organ that comes out from the first part of the large intestine.

It is removed when it becomes swollen (inflamed) or infected. An appendix that has a hole in it (perforated) can leak and infect the entire abdomen area, which can be life threatening.
The appendix is a closed-ended, narrow tube that attaches to the cecum like a worm.. The wall of the appendix contains lymphatic tissue that is part of the immune system for making antibodies. Like the rest of the colon, the wall of the appendix also contains a layer of muscle.

See also: Peritonitis An appendectomy is done using either:


Spinal anesthesia. Medicine is put into your back to make you numb below your waist. You will also get medicine to make you sleepy. General anesthesia. You will be asleep and not feel any pain during the surgery.

The surgeon makes a small cut in the lower right side of your belly area and removes the appendix. The appendix can also be removed using small surgical cuts and a camera. This is called a laparoscopic appendectomy. If the appendix broke open or a pocket of infection (abscess) formed, your abdomen will be washed out during surgery. A small tube may be left in the belly area to help drain out fluids or pus.

Why the Procedure is Performed


An appendectomy is done for appendicitis. The condition can be hard to diagnose, especially in children, older people, and women of childbearing age. Most often, the first symptom is pain around your belly button.

The pain may be mild at first, but it becomes sharp and severe. The pain often moves into your right lower abdomen and becomes more focused in this area.

Other symptoms include:


Diarrhea or constipation Fever (usually not very high) Nausea and vomiting Reduced appetite

If you have symptoms of appendicitis, seek medical help right away. Do not use heating pads, enemas, laxatives, or other home treatments to try and relieve symptoms.

Your health care provider will examine your abdomen and rectum. Other tests may be done.

Blood tests, including a white blood cell count (WBC), may be done to check for infection. When the diagnosis is not clear, the doctor may order a CT scan or ultrasound to make sure the appendix is the cause of the problem.

There are no actual tests to confirm that you have appendicitis. Other illnesses can cause the same or similar symptoms. The goal is to remove an infected appendix before it breaks open (ruptures). After reviewing your symptoms and the results of the physical exam and medical tests, your surgeon will decide whether you need surgery. Even when the surgeon finds that the appendix is not infected, it will be removed to prevent future problems.

Risks
Risks from any anesthesia include the following:

Reactions to medications Problems breathing

Risks from any surgery include the following:


Bleeding Infection

Other risks with an appendectomy after a ruptured appendix include the following:

Buildup of pus, which may need draining and antibiotics Longer hospital stays Side effects from medications

After the Procedure


Patients tend to recover quickly after a simple appendectomy. Most patients leave the hospital in 1 - 2 days after surgery. You can go back to your normal activities within 2 - 4 weeks after leaving the hospital. Patients who have the appendix removed through small surgical cuts tend to recover and get back to their daily activities faster.

Recovery is slower and more complicated if the appendix has broken open or an abscess has formed. Living without an appendix causes no known health problems.

APPENDECTOMY SET
An appendectomy is an emergency type of surgical procedure; the purpose of which is the removal of the inflamed vermiform appendix. Once surgical intervention is not performed, the inflamed appendix could rupture and cause systemic infection, and consequently, lead to death. The operation involves making an incision over the Mc Burneys point, and the different layers of the abdomen are opened. Next, upon gaining entrance in the peritoneum, the appendix is identified. The appendix is immobilized and then ligated. Finally, each layer of the abdominal wall is closed. The goal of appendectomy is to relieve the pain through the removal of the inflamed organ. For this procedure, an appendectomy set is utilized by surgeons. Blacksmith Surgical has an Appendectomy Set that helps surgeons perform more efficiently during the operative procedure. The set is composed of a comprehensive sixty-seven (67) pieces of instruments. Some of the most important instruments are the scissors and forceps. The Metzenbaum scissors are used for cutting delicate tissues while the Mayo scissors are used for cutting body tissues near the surface of the wound. Allis forceps are included for grasping fascia and tendons, the Mc Indoe for dissection and the Babcocks for holding a short part of the intestine without compressing it. Instruments for haemostasis are used too, like the Criles Forceps and Spencer Wells. For the retraction of the incision, a special US Army Retractor is employed. Along with these, Blacksmith Surgical adds the most basic surgical tools in the Appendectomy Set like the Kochers, Lane and Adson forceps, scalpel handles and needle holders, gallipots and kidney dishes, and others are included in the set. The surgeons prefer surgical instruments that help them perform their operation well. They need reliable scissors that would cut through delicate tissues easily. Apart from purpose, the durability is also taken note of. The highest priority in any operative procedure is to make sure that every step of the process is done skilfully. Blacksmith Surgical has the Appendectomy Set that will make the goal possible. The company promises production of high end instruments made by enhanced materials because it aims to fulfil its vision to improve the quality of life of people through manufacturing great instruments. The companys product line is composed of thousands of patterns of precision crafted instruments. Blacksmith Surgical guarantees that every instrument is made of sturdy, best quality stainless steel, designed to exacting resistance and measurements and meticulously subjected to test for reliability and safety.

Appendectomy is the surgical removal of the appendix when an infection has made it inflamed and swollen. This infection, called appendicitis, is considered an emergency because it can be life threatening if untreated occasionally, an inflamed appendix bursts after a day of symptoms. So it's very important to have it removed as soon as possible. Fortunately, appendectomy is a common procedure and complications are rare. And if appendicitis is promptly diagnosed and an appendectomy is performed, most kids recover quickly and with little difficulty.
About Appendicitis

Located in the abdomen, the appendix is a small organ that isn't important to a person's health. One end of the appendix is closed and the other opens into the large intestine, the organ that absorbs water from waste (or stool) and moves it out of the body through the anus.

Causes

There's no way to prevent appendicitis. Because the appendix is so close to the large intestine, it can become clogged with stool and bacteria. Other times mucus produced by the appendix can thicken and cause a blockage. In both cases, once the opening to the appendix is congested, it can become inflamed and swollen, causing appendicitis.

Signs and Symptoms

Appendicitis can cause sudden pain in the middle of the abdomen, usually concentrated around the bellybutton. The pain often moves to the lower right part of the abdomen. At first, pain might come and go, then become persistent and sharp. Appendicitis also can cause:

loss of appetite fever nausea vomiting diarrhea frequent or painful urination

If the appendix bursts, a child can develop a high fever, and pain will move throughout the abdominal area.

An appendectomy is the surgical removal of the appendix, which is located in the right lower side of the abdomen. This operation is usually carried out on an emergency basis to treat appendicitis (inflamed appendix). This may occur as a result of an obstruction in part of the appendix. Another name for this operation is an appendicectomy. Some common symptoms of appendicitis are nausea, vomiting, constipation and pain. The pain is initially felt in the centre of the abdomen and later moves to become a sharper pain in the right lower abdomen. The area is tender to the touch. Occasionally, some of these symptoms may be absent and it becomes necessary to investigate the abdominal cavity to make a diagnosis.

Problems associated with appendicitis


Appendicitis occurs when the appendix is blocked and becomes infected due to an invasion of intestinal bacteria. There is no single cause, but appendicitis may be due to:

A bowel adhesion Swelling of the lymphatic tissue of the appendix due to a viral infection A foreign body A faecalith (a small, hard mass of faeces), which causes blockage, inflammation and infection.

If appendicitis is left untreated, it may cause the appendix to rupture (burst). If the appendix ruptures, the infected contents flow into the abdominal cavity. This can cause a much more serious medical emergency known as peritonitis, which is inflammation of the membranes lining the abdominal wall and organs. Without prompt treatment, peritonitis can be life threatening.

Surgery is the preferred treatment for appendicitis. Delaying the operation (in the hope that the appendix will 'settle down') only increases the risk of suffering a ruptured appendix.

Medical issues to consider


Once in hospital, your temperature, pulse, breathing pattern and blood pressure will be charted. If the surgeon suspects your appendix shows signs that it may rupture, you will be taken to the operating theatre as soon as possible. Where the diagnosis is less clear, further examination using methods such as CT scans or ultrasound and blood tests may be needed before a decision to operate can be made.

Appendectomy procedure
The two main surgical techniques include open and laparoscopic appendectomy. These involve:

Open appendectomy an incision is made through the skin, the underlying tissue and the abdominal wall in order to access the appendix. Laparoscopic appendectomy this 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.

The type of operation you have will depend on how severe your appendicitis is. The surgeon will discuss your options with you. 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 is cut and removed. In laparoscopic appendectomy, the appendix is removed through one of the small incisions.

Immediately after appendectomy


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.

Medical treatment for peritonitis


If your appendix ruptures and you develop peritonitis, you will have antibiotics prescribed. Your surgeon will need to drain out the infected material and disinfect your abdominal cavity. A nasogastric tube (feeding tube through the nose) may need to be inserted into your stomach for a day or two, and intravenous fluids will be administered into a vein in your arm. You can expect a longer hospital stay.

Complications of appendectomy
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 about 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.

Taking care of yourself at home after appendectomy


Be guided by your doctor, but general suggestions include:

Follow the dietary advice you are given. You may like to use a mild laxative for the first few days. Drink plenty of water every day to help prevent constipation. Make sure you have adequate rest. A fast lifestyle, with inadequate diet, will slow your recovery. Avoid lifting heavy objects and stair climbing, so that you don't strain your abdominal muscles. After a few days, slowly resume your normal activities. Include regular, gentle exercise.

Long-term outlook after appendectomy


The appendix appears to be a redundant organ, since the human body manages quite well without it. There is no chance of ever experiencing appendicitis again, because the appendix is entirely removed.

Where to get help


Your doctor Emergency department of your nearest hospital In an emergency, always call triple zero (000)

Things to remember

Appendectomy is surgery to remove the appendix, which is usually found in the right lower side of the abdomen. Appendectomy is usually carried out on an emergency basis to treat appendicitis (inflamed appendix). A ruptured appendix can cause peritonitis, which is a potentially life-threatening complication Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to peritonitis and shock.[1] Reginald Fitz first described acute and chronic appendicitis in 1886,[2] and it has been recognized as one of the most common causes of severe acute abdominal pain worldwide. A correctly diagnosed non-acute form of appendicitis is known as "rumbling appendicitis".[3] The term "pseudoappendicitis" is used to describe a condition mimicking appendicitis

Signs and symptoms

Location of the appendix in the digestive system

Pain first, vomiting next and fever last has been described as the classic presentation of acute appendicitis. Since the innervation of the appendix enters the spinal cord at the level T10, the same level as the umbilicus (belly button), the pain begins mid-abdomen. Later, as the appendix becomes more inflamed and irritates the adjoining abdominal wall, it tends to localize over several hours into the right lower quadrant, except in children under three years. This pain can be elicited through various signs and can be severe.

Signs include localized findings in the right iliac fossa. The abdominal wall becomes very sensitive to gentle pressure (palpation). Also, there is severe pain on sudden release of deep pressure in the lower abdomen (rebound tenderness). In case of a retrocecal appendix (appendix localized behind the cecum), however, even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix), the reason being that the cecum, distended with gas, protects the inflamed appendix from the pressure. Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity. In such cases, a digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney's point) and this is the least painful way to localize the inflamed appendix. If the abdomen on palpation is also involuntarily guarded (rigid), there should be a strong suspicion of peritonitis, requiring urgent surgical intervention.[6]

Causes
On the basis of experimental evidence, acute appendicitis seems to be the end result of a primary obstruction of the appendix lumen (the inside space of a tubular structure).[7][8] Once this obstruction occurs, the appendix subsequently becomes filled with mucus and swells, increasing pressures within the lumen and the walls of the appendix, resulting in thrombosis and occlusion of the small vessels, and stasis of lymphatic flow. Rarely, spontaneous recovery can occur at this point. As the former progresses, the appendix becomes ischemic and then necrotic. As bacteria begin to leak out through the dying walls, pus forms within and around the appendix (suppuration). The end result of this cascade is appendiceal rupture (a 'burst appendix') causing peritonitis, which may lead to septicemia and eventually death. The causative agents include foreign bodies, trauma, intestinal worms, lymphadenitis, and, most commonly, calcified fecal deposits known as appendicoliths or fecaliths[9] The occurrence of obstructing fecaliths has attracted attention since their presence in patients with appendicitis is significantly higher in developed than in developing countries,[10] and an appendiceal fecalith is commonly associated with complicated appendicitis.[11] Also, fecal stasis and arrest may play a role, as demonstrated by a significantly lower number of bowel movements per week in patients with acute appendicitis compared with healthy controls.[12] The occurrence of a fecalith in the appendix seems to be attributed to a rightsided fecal retention reservoir in the colon and a prolonged transit time.[13] From epidemiological data, it has been stated that diverticular disease and adenomatous polyps were unknown and colon cancer exceedingly rare in communities exempt from appendicitis.[14][15] Also, acute appendicitis has been shown to occur antecedent to cancer in the colon and rectum.[16] Several studies offer evidence that a low fiber intake is involved in the pathogenesis of appendicitis.[17][18][19] This is in accordance with the occurrence of a right-sided fecal reservoir and the fact that dietary fiber reduces transit time.[20]

Diagnosis
Diagnosis is based on patient history (symptoms) and physical examination backed by an elevation of neutrophilic white blood cells. Histories fall into two categories, typical and atypical. Typical appendicitis usually includes abdominal pain beginning in the region of the umbilicus for several hours, associated with anorexia, nausea or vomiting. The pain then "settles" into the right lower quadrant (or the left lower quadrant in patients with

situs inversus totalis), where tenderness develops. A commonly used acronym for diagnosis is PALF: pain, anorexia, leukocytosis, and fever. Atypical histories lack this typical progression and may include pain in the right lower quadrant as an initial symptom. Atypical histories often require imaging with ultrasound and/or CT scanning.[21] A pregnancy test is vital in all women of child bearing age, as ectopic pregnancies and appendicitis present similar symptoms. The consequences of missing an ectopic pregnancy are serious, and potentially life threatening. Furthermore the general principles of approaching abdominal pain in women (in so much that it is different from the approach in men) should be appreciated.

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Appendectomy (cont.)

1. Appendicitis & Appendectomy Slideshow Pictures Medical Author: Dennis Lee, MD Medical Editor: Jay W. Marks, MD In this Article

What is the appendix? What is appendicitis? What are the complications of appendicitis? What are the symptoms of appendicitis? How is appendicitis diagnosed? Why can it be difficult to diagnose appendicitis? What other conditions mimic appendicitis? How is appendicitis treated? How is an appendectomy done? What are the complications of appendectomy? Are there long-term consequences of removing the appendix? Appendectomy At A Glance Patient Comments: Appendectomy - Describe Your Experience

Find a local Doctor in your town Appendectomy Index

Appendectomy At A Glance

The appendix is a small, worm-like appendage attached to the colon. Appendicitis occurs when bacteria invade and infect the wall of theappendix. The most common complications of appendicitis are abscess and peritonitis. The most common manifestations of appendicitis are pain, fever, andabdominal tenderness. Appendicitis usually is suspected on the basis of a patient's historyand physical examination; however, a white blood cell count, urinalysis, abdominal x-ray, barium enema, ultrasonography, CT, and laparoscopy also may be helpful in diagnosis. Due to the varying size and location of the appendix and the proximity of other organs to the appendix, it may be difficult to differentiate appendicitis from other abdominal and pelvic diseases. The treatment for appendicitis usually is antibiotics and removal of the appendectomy. Complications of appendectomy include wound infection and abscess.

How is an appendectomy done? During an appendectomy, an incision two to three inches in length is made through the skin and the layers of the abdominal wall in the area of the appendix. The surgeon enters the abdomen and looks for the appendix, usually located in the right lower abdomen. After examining the area around the appendix the surgeon must be certain that no additional problem is present when the appendix is removed. This is done by freeing the appendix from its attachment to the abdomen and to the colon, cutting the appendix from the colon, and sewing the over the hole in the colon. If an abscess is present, the pus can be drained with drains (rubber tubes) that go from the abscess and out through the skin. The abdominal incision then is closed. Newer technique for removing the appendix involve the use of the laparoscope. The laparoscope is a thin telescope attached to a video camera that allows the surgeon to inspect the inside of the abdomen through a small puncture wound (instead of a larger incision). If appendicitis is found, the appendix can be removed with special instruments that can be passed into the abdomen, just like the laparoscope, through small puncture wounds. The benefits of the laparoscopic technique include less post-operative pain (since much of the post-surgery pain comes from incisions) and a speedier recovery. An additional advantage of laparoscopy is that it allows the surgeon to look inside the abdomen to make a clear diagnosis in cases in which the diagnosis of appendicitis is in doubt. For example, laparoscopy is especially helpful in menstruating women in whom a rupture of an ovarian cysts may mimic appendicitis. If the appendix is not ruptured (perforated) at the time of surgery, the patient generally is sent home from the hospital in one or two days. Patients whose appendix has perforated generally are sicker than patients without perforation. After surgery, their hospital stay often is prolonged (four to seven days), particularly if peritonitis has occurred. Intravenous antibiotics are given in the hospital to fight infection and assist in resolving any abscess.

Occasionally, the surgeon may find a normal-appearing appendix and no other cause for the patient's problem. In this situation, the surgeon may remove the appendix. The reasoning in these cases is that it is better to remove a normal-appearing appendix than to miss and not treat appropriately an early or mild case of appendicitis

The most common complication of appendectomy is infection of the wound, that is, of the surgical incision. Such infections vary in severity from mild, with only redness and perhaps some tenderness over the incision, to moderate, requiring only antibiotics, to severe, requiring antibiotics and surgical treatment. Occasionally, the inflammation and infection of appendicitis are so severe that the surgeon will not close the incision at the end of the surgery because of concern that the wound is already infected. Instead, the surgical closing is postponed for several days to allow the infection to subside with antibiotic therapy and make it less likely for infection to occur within the incision. Another complication of appendectomy is an abscess, a collection of pus in the area of the appendix. Although abscesses can be drained of their pus surgically, there are also non-surgical techniques, as previously discussed. Are there long-term consequences of appendectomy? It is not clear if the appendix has an important role in the body in older children and adults. There are no major, long-term health problems resulting from removing the appendix although a slight increase in some diseases has been noted, for example, Crohn's disease.

Introduction

In recent years, the incidence of appendicitis has markedly decreased. Nevertheless, appendicitis remains one of the more common surgical emergencies, and appendectomy remains the treatment of noncomplicated appendicitis.
History of the procedure

The first report of an appendectomy came from Amyan, a surgeon of the English army. Amyan performed an appendectomy in 1735 without anesthesia to remove a perforated appendix. Reginald H. Fitz, an anatomopathologist at Harvard who advocated early surgical intervention, first described appendicitis in 1886. However, because he was not a surgeon, his advice was ignored for a time.

Then, at the end of the 19th century, the English surgeon H. Hancock successfully performed the first appendectomy in a patient with acute appendicitis. Some years after this, the American C. McBurney published a series of reports that constituted the basis of the subsequent diagnostic and therapeutic management of acute appendicitis. Thousands of classic appendectomieshave been performed in the last 2 centuries. Mortality and morbidity have gradually decreased, especially in the last few decades because of antibiotics, early diagnosis, and improvements in anesthesiologic and surgical techniques.
Open versus laparoscopic appendectomy

Open appendectomy remains the most common approach due to operative time and cost. Since 1987, however, an increasing number of surgeons have come to prefer laparoscopic appendectomy. Laparoscopic appendectomy has now been improved and standardized.[1] Laparoscopic appendectomy has some advantages, including decreased postoperative pain, better aesthetic result, a shorter time to return to usual activities, and lower incidence of wound infections or dehiscence. This procedure is cost-effective but may require more operative time compared with open appendectomy. Kouhia et al found that by 2008, operative time with laparoscopic appendectomy was only 10 minutes longer than with the open approach. In addition, patients who underwent open appendectomy returned to work later and had more complications.[9] The reported results of laparoscopic and open-procedure appendectomies seem to overlap. In fact, the average rate of abdominal abscesses, negative appendectomies, and hospital stays are very similar, according to an overview of 17 retrospective studies.[2]
Key Considerations

Patients with appendicitis always need urgent referral and prompt treatment. An appendectomy is generally indicated for patients with a history of persistent abdominal pain, fever, and clinical signs of localized or diffuse peritonitis, especially if leukocytosis is present (see Indications). Open appendectomy is the most common approach due to time and cost. However, an increasing number of surgeons prefer laparoscopic appendectomy, especially in female patients, due to its diagnostic ability (see Technique). If, on open appendectomy, the surgeon finds an apparently normal appendix, he or she is faced with a dilemma: remove the appendix, or leave it in place? The argument for performing appendectomy is that even if the appendix is not removed, the patient will have a scar from a right lower quadrant incision. In the future, this may lead those who examine the patient to assume that an appendectomy has been performed and they will not include appendicitis in the differential diagnosis.

At the opposite extreme, in the past, appendicitis sometimes was so severe that the cecum appeared necrotic. Today, this finding is fortunately very rare. In such cases, perform an ileocecectomy or right hemicolectomy with a primary anastomosis.
Indications

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. If the clinical picture is unclear, a short period (4-6 h) of watchful waiting and a computed tomography (CT) scan may improve diagnostic accuracy and help to hasten the diagnosis. However, if a patient is discharged from the medical center without a definite diagnosis at the end of the observation period, instruct the patient to return if symptoms continue or recur, and the patient may benefit from a follow-up examination in 24 hours.
Contraindications

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). Certain contraindications exist for laparoscopic appendectomy. These contraindications are extensive adhesions, radiation or immunosuppressive therapy, severe portal hypertension, and coagulopathies. Laparoscopic appendectomy is contraindicated in the first trimester of pregnancy. Rarely, an appendiceal mucocele (ie, a collection of mucus within the appendiceal lumen) may occur. Occasionally, patients may present with a low-grade carcinoma of the appendix or the cecum. In such cases, the surgeon must avoid perforation during dissection, because it may cause seeding of the peritoneum with viable cells, leading to pseudomyxoma peritonei