Definition Acute appendicitis.
Acute appendicitis or appendectomy is the removal of appendix at the cecum (right and bottom of the womb) that is swollen. The appendix is a small pouch of intestinal tissue when infected (appendicitis) must be removed before they evolve into a perforation or peritonitis.
Questions and answers acute appendicitis.
What are symptoms in acute appendicitis?
Abdominal pain from the start in center of the abdomen (stomach area) is irradiated to the right side and bottom, accompanied by fever, nausea and vomiting. The exploration by the surgeon discovers a zone defense and hardness with compressive pain in the belly where is the appendix. There is a fever of up to 38 degrees or more and in the analysis of bleeding are increased white blood cells (leukocytes)
How do you operate an acute appendicitis?
If the conventional or open surgery with little or medina incision on the right side and lower abdomen, which allows access to the abdominal cavity and remove the inflamed appendix. Another technique that can be used is the removal by laparoscopy, which is a matter of some controversy, because even have some advantages over the conventional route in time of hospitalization, wound complications, adhesion formation and aesthetic aspects. In a small percentage of cases are due to convert to open surgery, without this being a serious problem.
The main problem for generalization is that it requires equipment and skilled in the art given the high frequency of appendicitis in all hospitals at all levels and simplicity of open surgery has not been in widespread use.
How is the recovery after the removal of the appendix?
Recovery from a simple appendectomy is usually complete and rapid incorporation into the life and normal activity. Only in cases of complicated appendicitis (abscess or perforation) recovery is slower in every way. You can live without appendix and will not cause any known health problem Convalescence is short and patients leave the hospital within 1-3 days of the operation can resume normal activities within 3 weeks of operation.
Deaths still occur from complications arising from undiagnosed acute appendicitis and evolved. In the presence of symptoms such as pain on the right side and lower abdomen, fever, nausea and vomiting, you should not delay emergency consultation as soon as possible, not wasting time on medication or treatment of any effective domestic.
Acute appendicitis laparoscopic surgery.
The development of the intervention should follow a clear and well defined from the beginning to the end of the procedure. Although the sequence of different times can be varied according to the findings of each case, all steps must be carefully observed.
Distribution of the operating room and patient preparation
In patient is placed supine and Trendelenburg, with the left arm abducted. The surgeon and assistant, left the patient in front laparoscopic monitor. You do not need the placement of a nasogastric tube. Catheterization should be performed, if the anticipated long-term procedure.
Creation of Pneumoperitoneum.
Not unlike the one made in either, laparoscopic technique. Although the type of pathology that affects the population and acute appendicitis, requires consideration of some particular considerations, liquid cavity free of acute appendicitis evolved, may hinder inflation, by plunging the tip of the Verres needle in the liquid, the inflammatory process may have produced omental adhesions, which makes finding a free area to the tip of the needle
Have any difficulty in inflation, it must choose, for the realization of pneumoperitoneum with "open technique" using the trocar Hansson with direct vision, is easy and quick installation, obviating this method, all the problems described above
Placement of the trocars.
After a pressure of 13 mm Hg, with good muscle relaxation, allowing an acceptable intra-abdominal evisceration of the wall, we introduce the first trocar of 10 mm and is not necessary if you have used the trocar Hansson. Then under visual laparoscopic trocars are placed two more: 10 mm at the top right of the vacuum on the anterior axillary line and in higher position than the blind, and 12 mm on the inside and bottom of the iliac fossa Left.
Exploration of the abdominal cavity
The lens is inserted through the umbilical door and found initially periumbilical abdominal area to rule out any injury sustained during the performance of pneumoperitoneum. Then it displays all quadrants of the abdomen.
The hyperemic-inflammatory aspect of the abdominal viscera and all located in the right iliac fossa, guide the site of injury, which is usually to lift the overlying omentum, assessing then the degree of inflammation of the appendix to be sought Then, the existence of liquid collection, declines in areas of the abdominal cavity and the contents may be serous, sero-purulent or purulent.
Location of the Appendix.
The location of the appendix, as in conventional surgery, it may be easy or extremely difficult, may be enhanced by playing with the mobility and positioning of the operating table (supine, train and antritrendelemburg). The technique to locate no different to what is done in open surgery: follow the tapeworms of the ascending colon to the cecum and ileocecal valve and if necessary, mobilization of the cecum with section peritoneal reflection at the right colic gutter parieto.
Dissection of the appendiceal base.
Having identified the base appendiceal mesoappendix is dissected next to the blind, creating a large window (with dissector or scissors), which allows individual ligation of the mesoappendix apendiculary base.
Ligation and section of the mesoappendix.
This time may be before or after the next, depending on the characteristics of each case and surgeon preference. The technique used will depend on how advanced the inflammatory process and the anatomy of the mesoappendix. Sometimes, in cases of appendicular plastrons and abscesses, the extent of inflammation has coagulated meso it not being necessary selective ligation of the artery appendicular
Ligation and section of the appendiceal base.
Like the mesoappendix, the appendix base can be tied with string, paper clips or stapler EndoGIA, depending on their characteristics and the effect on the inflammatory process.
In cases of non-inflamed appendicular base and extremely thin, ligation may be performed with metal clips and proceed as with wire bonds. After the section of the appendix, can reinforce the closure with a complementary loop.
Cavity washing and review of hemostasis.
This phase of the intervention is very important and it must devote all your time. One of the advantages of the laparoscopic approach is the visualization of the entire peritoneal cavity, allowing extensive washing and cleaning local extreme of the infectious process to condition a postoperative This more rapid clinical recovery of the patient.
Removal of the appendix.
The extraction of the appendix, must be made so that no contact with the abdominal wounds to prevent contamination and infection. If you take the precaution of cutting the mesoappendix close to appendix removal through the trocar sheath 12 mm, it is often feasible.
Withdrawal of trocars and wound closure.
The withdrawal of the trocars under direct vision is performed to check hemostasis of wounds and dismiss occult blood in the abdominal cavity, which can compromise the success of the intervention.
Laparoscopic surgery postoperative.
The postoperative course of laparoscopic appendectomy is very fast and kind, if the technique is successful. The onset of fluid intake and ambulation of the patient, usually early, after the disappearance of the anesthetic effects. In the early hours you can see signs of peritoneal irritation in the right iliac fossa, similar to the pre-intervention, which disappear gradually depending on the pain sensitivity of each patient.
Any delay in the recovery of ileus, abdominal pain disappearance or maintenance of fever, to suspect a complication