may be performed laparoscopically
or as an open operation. Laparoscopy
is often used if the diagnosis is
in doubt, or if it is desirable
to hide the scars in the umbilicus
or in the pubic hair line.
(or appendectomy) is the
surgical removal of the vermiform appendix.
This procedure is normally performed as
an emergency procedure, when the patient
is suffering from acute appendicitis. In
the absence of surgical facilities, intravenous
antibiotics are used to delay or avoid the
onset of sepsis; it is now recognised that
many cases will resolve when treated non-operatively.
In some cases the appendicitis resolves
completely; more often, an inflammatory
mass forms around the appendix. This is
a relative contraindication to surgery.
Recovery may be a little quicker with laparoscopic
surgery; the procedure is more expensive
and resource-intensive than open surgery
and generally takes a little longer, with
the (low in most patients) additional risks
associated with pneumoperitoneum (inflating
the abdomen with gas). Advanced pelvic sepsis
occasionally requires a lower midline laparotomy.
general terms, the procedure for an open
appendicectomy is as follows.
are given immediately if there are signs
of sepsis, otherwise a single dose of prophylactic
intravenous antibiotics is given immediately
prior to surgery.
anaesthesia is induced, with endotracheal
intubation and full muscle relaxation, and
the patient is positioned supine.The
abdomen is prepared and draped and is examined
under anaesthesia. If a mass is present,
the incision is made over the mass;[citation
needed] otherwise, the incision is made
over McBurney's point, one third of the
way from the anterior superior iliac spine
(ASIS) and the umbilicus; this represents
the position of the base of the appendix
(the position of the tip is variable).
An inflamed appendix can be life-threatening,
particularly if the patient is out of reach
of medical care. Historical records show
a number of appendectomies carried out by
unskilled ad hoc surgeons, communicating
with a base hospital by telephone or even
To find the cause of unexplained abdominal
pain, exploratory surgery is sometimes performed.
If the cause of symptoms does not lie in
the appendix, the surgeon will thoroughly
check the other abdominal organs and remove
the appendix anyway, to prevent problems
in the future. Recent findings on the possible
usefulness of the appendix has led to an
abatement of this practice.
If appendicitis develops during pregnancy,
an appendectomy is usually performed and
should not harm the fetus.