Removal of appendicitis and operation of purulent appendicitis

Among diseases of the gastrointestinal tract, appendicitis is not the last place. Doctors still have not found the answer to the purpose of this organ, ways to prevent inflammation and the causes leading to this disease.

Therefore, when inflammation occurs, doctors perform an operation for appendicitis. There are various stages of the disease in which a planned or emergency operation is required.

If the appendicitis is purulent, the appendicitis is removed by laparotomy and laparoscopy.

How to remove the inflamed organ, how long does the operation to remove appendicitis take and how to determine the pathology, more on this.

Suppurative appendicitis

Operation of appendicitis is a very common surgical intervention, accounting for 30% of all cases.

Pathology affects older people, it is more common in women than in men. In childhood and old age, it is rare, more difficult, difficult to diagnose.

This disease often becomes the cause of peritonitis. If the diagnosis is correct and the appendicitis was excised on time, the prognosis is favorable. If complications arise, the prognosis worsens.

Causes

There are several theories of the occurrence of purulent appendicitis:

• mechanical;
• infectious;
• vascular;
• endocrine.

The appendix acts as a filter for the organs of the digestive system. The mechanical theory assumes the development of purulent appendicitis due to the structure of the organ.

It has poor blood supply, a thin lumen, and often bends. This leads to blockage of the lumen with fecal stones (coprolites).

They are not formed in the intestinal cavity in all people. They are formed due to insufficient intake of fluids, fiber, genetic and individual characteristics.

Sometimes the cause of the blockage of the lumen is lymphatic follicles, tumor formations, parasites, and a foreign body.

When the lumen is blocked in the cavity, strong pressure is formed, the blood supply deteriorates, and the pathogenic flora is actively developing. An inflammatory process arises and progresses, leading to necrosis, wall perforation. The inflammation spreads to the abdominal cavity, and peritonitis is formed.

Fewer physicians are inclined to theories that pathology develops for vascular and endocrine reasons.

In the first case, the causes are vasculitis in primary appendicitis in the elderly.

In the endocrine theory, the process is considered as an organ in which specific cells accumulate that secrete serotonin, which is an inflammatory hormone.

There are various ways of penetration of infection into the process, leading to the inflammatory process.

Symptoms

The first sign of purulent appendicitis is pain. Initially, pain appears in the epigastric region, gradually moving to the iliac region.

The nature of the pain effect is moderate, constant, dull, aggravated by lying on the left side, by sneezing and coughing.

With the progression of inflammation, nerve fibers die off, so the pain can subside, temporarily disappear.

After a couple of hours, the pain returns, intensifies, body temperature rises, signs of intoxication appear.

Often, patients are worried about nausea, vomiting, diarrhea. Less often, tachycardia occurs, blood pressure rises.

The initial stage of the disease is accompanied by a slight increase in temperature - up to 38 ° C.

With an untimely appeal to the doctor and the absence of help, significant complications can arise.

The formation of an appendicular abscess is possible, the process can spread to neighboring organs.

If the appendicitis operation was not performed on time, serious consequences are possible. A complication of the disease can be represented by peritonitis, which in a couple of hours leads to an abscess around the appendix, under the liver, in the pelvic area.

This leads to necrosis of the intestinal walls, adhesions, fistulas are formed, intestinal obstruction, and other dangerous pathologies are formed.

Treatment

For the treatment of purulent appendicitis, only surgical intervention is used. In order to accurately determine the medical report, the patient is sent for observation to the department of gastroenterology and surgery.

There they establish an accurate diagnosis, prepare for the operation. To do this, they sanitize, tightly bandage the limbs, and inject heparin.

When the patient eats food 6 hours before the operation, it is necessary to wash the stomach using a probe.

The bladder is emptied. Sometimes sedatives are prescribed to facilitate the transfer of anesthesia and surgery.

There are several ways of performing surgery: classical and laparoscopic.

The classical method of surgery is rarely used, since the removal of appendicitis by the laparoscopic method very rarely causes complications.

The list of advantages of this method includes an easy course of the postoperative period, recovery from appendicitis is faster.

After the intervention, no scars remain on the body, the wound rarely becomes inflamed after the operation.

In case of complications in the form of perforation, peritonitis, peritoneal abscesses, the classical method of appendectomy is used.

It allows for a thorough revision of the peritoneum. With its help, adhesions, abscesses are detected, and the foci of inflammation are sanitized.

Recovery after appendicitis involves adherence to a special diet, limiting physical activity.

The patient should be regularly examined by a therapist, surgeon. Particular attention is paid to the care of the postoperative wound.

Laparoscopy

Laparoscopy of appendicitis is performed quite often. This method allows surgical intervention without open surgery.

Many young surgeons begin their practice with the classical method. As they developed and gained experience, doctors mastered more complex technologies, preferring a new method.

The classic appendectomy method has several disadvantages. Among them are high trauma, frequent complications, long-term recovery from appendicitis.

Laparoscopy of appendicitis also has advantages and disadvantages. There are significantly fewer minuses than pluses.

Therefore, given the technical possibilities, this method of operation is preferred. Even complicated appendicitis can be operated with it.

Advantages and disadvantages

With laparoscopy, rapid recovery from appendicitis is noted. What other advantages does this method of surgery have:

• After the operation, there are no rough scars, good cosmetic result;
• Lack of adhesive disease, fewer complications;
• Less trauma;
• Working capacity is quickly restored;
• The organs of the abdominal cavity are fully examined, if necessary, additional surgical manipulations are carried out without increasing the surgical incision;
• Due to the short period of stay in the hospital in the postoperative period, there is a saving of money and drugs for treatment.

Flaws:

This method has its drawbacks - the obligatory presence of expensive equipment, personnel training and some concomitant diseases in which such an operation is contraindicated.

Indications

The procedure of laparoscopy for appendicitis is prescribed in such cases:

• Unclear diagnosis, which does not exclude the complete absence of an acute inflammatory process in the appendix. In this case, the diagnosis turns into therapy.
• Young women planning pregnancy in the future, in whom it is difficult to determine an attack of appendicitis from a gynecological disease. Unjustified appendectomy reaches high rates among females. As a result, adhesive disease is formed, leading to infertility.
• Women who strive for a neat cosmetic appearance after surgery.
• Patients suffering from concomitant diseases leading to purulent complications - obesity, diabetes mellitus.
• Children's age due to the low likelihood of developing adhesive disease.

Not only the external cosmetic appearance of the suture after surgery depends on how the appendicitis is cut out.

All the details should be weighed and the right decision should be made. The experience of surgeons and confidence in it plays a significant role in the choice of the method of surgical intervention.

Contraindications

In what cases laparoscopy is not performed:

• Complex forms of diseases of the heart, liver, kidneys;
• 3rd trimester of pregnancy;
• Poor blood clotting.

There are also local contraindications:

• Tight, inflammatory lump in and around the appendix
• Pronounced adhesive formation;
• An abscess, in which the injection of gas into the peritoneal region can rupture and lead to peritonitis.
• Peritonitis in a neglected form, the formation of a large conglomerate, consisting of intestinal loops, massive fibrious overlays, many abscesses requiring open surgery.

Preparatory activities

Before the appendix is ​​removed, always prepare for the operation. Laparoscopy is usually always done as a matter of urgency, but the minimum number of tests required is still done.

You will need a blood test, urine test, a coagulogram study, an ultrasound of the abdominal cavity, an analysis for HIV, hepatitis, syphilis, ECG.

All preoperative measures are carried out in the emergency room. The duration of the events is short, then the patient is transferred to surgery.

A surgeon, an anesthesiologist conduct a conversation with the patient. With complicated appendicitis, the operation is performed urgently.

If there are doubts about the need for surgery or the accuracy of the diagnosis, the operation can be postponed for a detailed study and diagnosis.

Stages of laparoscopy

Anesthesia must be used before surgery. The best way is general anesthesia with tracheal intubation, artificial lung ventilation.

If the patient has contraindications, epidural or intravenous anesthesia may be used.

In both cases, it will be more difficult to carry out surgery due to the inability to relax the muscle tissues of the abdominal walls.

On the operating table, the peri-umbilical area must be treated with an antiseptic. The first small incision is made, the Veress needle is inserted, and carbon dioxide is injected.

The first trocar for the laparoscope is placed in this hole. A second trocar is used to examine the area of ​​interest. It is injected into the left iliac region or midline.

When installing all the instruments, all internal organs are examined in detail, the condition of the appendix is ​​assessed.

If a fragment of inflammation is found, it is removed. The absence of visible inflammation may also indicate acute appendicitis, in which superficial and catarrhal forms require surgical intervention.

In uncomplicated forms of appendicitis, laparoscopy takes an average of 30 minutes. In the event of complications, the operation can be delayed.

For example, with peritonitis, the surgeon initially gets rid of the effusion, and then proceeds to the appendix itself.

At the first signs and symptoms of appendicitis, they immediately rush to the doctor. Lack of treatment leads to dangerous consequences.

Laparoscopy is a very effective method for removing the appendix. The technique has advantages that exceed disadvantages.

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