Appendectomy

Overview of Treatment

Appendectomy is a surgical procedure used to treat acute appendicitis, primarily aimed at removing the inflamed or ulcerated appendix to prevent rupture and subsequent peritonitis. This operation is usually performed immediately after diagnosis to prevent the spread of infection and life-threatening complications.

The surgery can be performed via traditional open surgery or laparoscopic approach, depending on the patient's condition and the surgeon's judgment. Indications include typical symptoms such as right lower abdominal pain, fever, or imaging confirmation of an enlarged appendix greater than 6mm. In emergency cases, surgery may be performed within 24 hours to reduce the risk of complications.

Types and Mechanisms of Treatment

There are two main types:

• Traditional open appendectomy: a 5-8 cm incision is made on the right lower abdomen to directly remove the appendix and suture.
• Laparoscopic appendectomy: using 3-4 small incisions to insert a camera and instruments for minimally invasive removal.

Both methods involve ligating blood vessels and removing the appendix. The laparoscopic approach results in smaller incisions but requires suitable anatomical conditions.

The mechanism involves removing the diseased tissue to prevent rupture and subsequent peritonitis or sepsis. Laparoscopic techniques can reduce tissue trauma but must be performed by experienced surgeons.

Indications

Mainly suitable for:

• Confirmed cases of acute appendicitis, such as elevated white blood cell count or an enlarged appendix over 6mm.
• Suspected perforation leading to peritonitis, presenting with diffuse abdominal tenderness and rebound pain.
• Recurrent appendicitis or formation of appendiceal fistula.

Special cases like late pregnancy require adjustment of surgical approach.

Contraindications are rare but include severe coagulopathy or systemic sepsis with shock, which may require stabilization before surgery. Careful assessment of cardiopulmonary function is necessary to evaluate anesthesia risks.

Usage and Dosage

The surgery requires general anesthesia, with hospital stay depending on the type of procedure:

• Laparoscopic surgery: 2-3 days, with incisions about 1-2 cm.
• Open surgery: 5-7 days, with longer wound recovery time.

Postoperative management includes pain control, antibiotics, and adherence to dietary instructions.

Drug dosages are not specified, but anesthesia doses are adjusted based on body weight and physiological indices. Elderly patients may require preoperative cardiopulmonary assessment and adjustment of anesthetic agents.

Benefits and Advantages

Main benefits include:

• Complete removal of the diseased tissue, preventing rupture.
• Laparoscopic approach reduces tissue trauma and accelerates recovery.
• Lower risk of severe complications such as peritonitis.

Long-term follow-up shows a recurrence rate of less than 1% for appendicitis after surgery.

The advantages include immediate resolution of emergency symptoms with a success rate exceeding 95%. Laparoscopic techniques can also reduce postoperative pain and scarring, making it suitable for young patients and obese cases.

Risks and Side Effects

Potential risks include:

• Wound infection or abscess formation (incidence approximately 5-10%).
• Bowel leak or obstruction (incidence approximately 1-3%).
• Anesthesia-related complications such as respiratory depression.

Severe complications may require secondary surgery or lead to long-term issues.

Laparoscopic surgery may increase residual carbon dioxide gas, causing shoulder pain, but this is usually temporary. Elderly patients may have increased risks due to compromised cardiopulmonary function, which requires special attention.

Precautions and Contraindications

Preoperative preparations include:

• Fasting for at least 8 hours and blood tests.
• Informing the medical team of allergies and current anticoagulant use (e.g., aspirin).

Absolute contraindications include patient refusal and uncontrolled systemic sepsis.

Relative contraindications include severe coagulopathy or heart failure, which should be managed with antibiotics before reassessment. Postoperative monitoring includes wound healing and return of bowel motility.

Interactions with Other Treatments

The surgery itself does not directly interact with medications, but attention should be paid to:

• Discontinuing anticoagulants (e.g., warfarin) 7 days before surgery.
• Timing of antibiotic administration, typically 30 minutes before skin incision.

When combined with chemotherapy or immunosuppressants, medication doses may need adjustment.

If the patient is on antiplatelet therapy (e.g., clopidogrel), a hematologist should evaluate bleeding risks. Diabetic patients should adjust preoperative blood sugar control plans.

Effectiveness and Evidence

Clinical studies show:

• Laparoscopic surgery results in shorter hospital stays (average 2.5 days vs 5 days).
• Five-year follow-up indicates a low incidence of chronic abdominal pain (<2%).
• Infection control rates for emergency and prophylactic surgeries are 98% and 100%, respectively.

Randomized controlled trials confirm that laparoscopic techniques have lower complication rates and higher patient satisfaction compared to traditional open surgery.

The American College of Surgeons recommends that all suspected appendicitis patients undergo surgical evaluation within 24 hours, as delays increase perforation risk by 2% per hour.

Alternative Options

In very rare cases, non-surgical treatments may be considered:

• Selective observation: limited to high-risk patients (e.g., end-stage renal failure) for short-term use.
• Antibiotic therapy: suitable for early mild inflammation with close monitoring.

However, success rates are about 70%, with a recurrence rate of 30%.

Alternative options require strict evaluation; immediate surgery is mandatory if inflammation exceeds 48 hours or perforation has occurred. Non-surgical treatment still requires regular imaging follow-up.

 

Frequently Asked Questions

What preparations are needed before surgery? What should be noted on the day of surgery?

Before undergoing appendectomy, patients should have blood tests, abdominal ultrasound or CT scans to confirm the diagnosis. Fasting for at least 8 hours and discontinuing anticoagulants as per medical advice are necessary. On the day of surgery, remove metal objects, change into surgical gown, and the medical team will explain the procedure and risks in detail before anesthesia.

What are the pain management options after surgery? How to determine if pain is abnormal?

Postoperative pain is usually controlled with analgesics (such as NSAIDs or opioids), combined with ice packs or gentle mobilization. Sudden worsening of pain, fever, or vomiting may indicate complications and require immediate medical attention. Patients should take medications as prescribed and avoid delaying activity and rehabilitation due to fear of pain.

How should diet be resumed after surgery? Are there foods to avoid?

Initially, a clear liquid diet such as rice porridge or apple juice is recommended, gradually progressing to low-fiber whole grains and soft foods. High-fat, high-fiber foods (fried foods, whole wheat) and dairy products should be avoided to prevent gastrointestinal discomfort. Recovery varies among individuals; gradual reintroduction of normal diet with monitoring is advised.

When should open surgery be considered instead of laparoscopic? How to assess risks?

If the appendix has perforated, severe inflammation, or intra-abdominal adhesions, laparoscopic surgery may be difficult, and open surgery is preferred. Risk assessment is based on age, obesity, and severity of infection; the surgeon will choose the safest approach and explain differences in recovery time.

How long does full recovery take? When can patients resume exercise or work?

Patients undergoing minimally invasive surgery can typically engage in light activities within 1-2 weeks, while open surgery may require 4-6 weeks for full recovery. Office work can usually resume after about 3 weeks, but lifting heavy objects or strenuous exercise should be avoided for at least 6 weeks. The surgeon will provide tailored advice based on wound healing and recovery progress, and early exertion should be avoided to prevent wound dehiscence.