Appendectomy

About Appendectomy

Appendectomy is the surgical removal of the appendix, most often performed as an emergency treatment for acute appendicitis, one of the most common causes of abdominal pain requiring surgery. The American pathologist Reginald Fitz described appendicitis as a distinct disease in 1886 and advocated early surgical removal. Laparoscopic appendectomy, first performed by the German gynecologist Kurt Semm in the early 1980s, is now the standard approach in many countries. A camera and instruments are passed through small ports, typically one at the umbilicus and two in the lower abdomen; the appendiceal artery in the mesoappendix is divided and the appendix is detached at its base with a stapler or looped ligature. Compared with open surgery it generally causes less pain, fewer wound infections and a quicker return to normal activity. Open appendectomy remains relevant for complicated cases with widespread peritonitis, when laparoscopic expertise or equipment is not available, or after conversion. It uses a right lower quadrant incision over McBurney point, one third of the way from the anterior superior iliac spine to the umbilicus, or a transverse Rockey Davis incision, with the abdominal muscles split along their fibers rather than cut; the appendix is located by following the taeniae coli to the cecum. Complications include wound infection, intra abdominal abscess and, rarely, inflammation of a retained appendiceal stump. Antibiotic treatment without surgery has been studied in randomized trials and is an option for selected patients with uncomplicated appendicitis, although some later need an operation. When an abscess has formed, initial drainage and antibiotics may be followed by a later interval appendectomy.