Surgical treatment of acute appendicitis
Acute appendicitis is the most common abdominal disease that requires urgent surgical intervention. This disease occurs due to acute inflammation of the appendix or appendix of the cecum. Inflammation of the appendix causes increased activation of the intestinal flora on the background of obstruction( blockage) of the opening between the cecum and vermiform appendage stones. Develops acute appendicitis very quickly - for one day. The main symptom of this disease is bouts of pain at the top of the abdomen from the right side. In this case, the patient, as a rule, increases body temperature. Acute appendicitis occurs most often in people aged 18 to 30 years. It is much less common in children and elderly people.
Classification of appendicitis
In modern medicine, acute appendicitis, depending on the degree of inflammation and the nature of morphological changes, is divided into simple, gangrenous, phlegmonous and perforated. Also it is classified according to the clinical picture - typical and atypical, in the prevalence of pathology - with dysuric disorders, with diarrhea, with symptoms of bile duct disease, with hyperpyrexia, with signs of purulent intoxication. The clinical course of acute appendicitis can be of the following types: regressive, not progressive, slow progressing, rapidly progressive.
Treatment of appendicitis
With inflammation of the appendix, the usual surgical treatment of acute appendicitis is applied - appendectomy( removal of the appendix of the cecum).With appendicitis, it is very important to make a correct diagnosis, since many diseases have similar symptoms. From the competent diagnosis depends on the timeliness of the operation. To establish the diagnosis, the history and objective, instrumental and laboratory examinations of the patient are taken into account. Appendicitis must be differentiated with such diseases: bacterial enterocolitis, pelvic inflammatory diseases, urolithiasis, intestinal colic and others.
Immediately after confirmation of the diagnosis the patient must be hospitalized and begin preoperative preparation.
Preparation for surgical operation is determined by an anesthesiologist and a surgeon, the condition of the patient is taken into account when performing it. Preoperative actions include hygienic measures, gastric emptying with a probe, catheterization of the bladder with acute peritonitis.
In the presence of indications, a pharmacological correction of disorders caused by background diseases and endogenous intoxication is necessary.
Currently, for the treatment of appendicitis in acute form, such methods of surgical procedures are used:
- appendectomy typical and atypical of laparotomy access;
- appendectomy typical and atypical laparoscopic;
- appendectomy from extra-abdominal access in the retroperitoneal position of the appendix.
The most preferred is the laparoscopic operation, in this case the appendix is removed through small punctures of the abdominal wall. In most cases, three such punctures are sufficient, which are carried out with the help of special tools. The most modern method of appendectomy is endoscopic intervention. Such surgical treatment is the most sparing, promotes rapid recovery and leaves almost no cosmetic defects. It is carried out with the help of a camera fixed to the end of a flexible, thin tube.
There are the following ways of stump of an appendix:
- subserosal( only mucus and submucosal layers of the appendage are bandaged, the stump is immersed in serous-muscular layers);
- ligature( all layers of stump are tied, thus they do not sink into the blind gut);
- without stump dressing.
In case of intestinal, hemorrhagic, biliary or purulent exudate( fluid with blood elements emerging from capillaries and small veins in case of inflammation) in case of acute appendicitis, and if the appendix can not be detected intraoperatively in a typical place, audit the peritoneal organs.
If there is gangrene, incomplete removal of the process, technical difficulties during the operation are performed by draining the abdominal cavity. It is preferable to conduct drainage through a separate incision. Drainages are of two types - polyvinyl chloride and silicone.
After removal of appendicitis, these abdominal seam options are used: - tightly;- With deducing of a drainage through a wound.
In the postoperative period, the patient should minimize the physical load as much as possible and follow a special diet to normalize the bowel.
In some cases, complications occur after surgical intervention, their causes may be: untimely care due to late treatment of the patient or late diagnosis of appendicitis, technical and tactical errors.
The most serious complications after removal of appendicitis are:
- abdominal abscess;
- bleeding into the cavity of the peritoneum;
- phlegmon of retroperitoneal space;
- intestinal obstruction.
Such complications require surgical treatment.