Panganiban, Krisanta Mae BSN 3 Orlando Group 2
APPENDECTOMY
Appendectomy is a surgical procedure aimed at removing the appendix, a small
pouch located at the junction of the small and large intestines. Typically performed in
response to appendicitis, a condition characterized by inflammation of the appendix
often due to blockage by fecal matter or infection. Appendectomy is the standard
surgical treatment for appendicitis, because an inflamed appendix has the potential
to rupture, appendicitis is considered a medical emergency.
Appendectomy can be performed using different surgical techniques depending on
factors such as the severity of appendicitis, patient's medical history, and surgeon's
preference. The primary types of appendectomy are open appendectomy and
laparoscopic appendectomy.
Open Appendectomy – an incision is made through the skin, the underlying
tissue and the abdominal wall in order to access the appendix.
Laparoscopic Appendectomy – this involves making three small incisions in
the abdomen, through which particular instruments are inserted. A gas is
gently pumped into the abdominal cavity to separate the abdominal wall from
the organs. This makes it easier to examine the appendix and internal organs.
The surgical site for an appendectomy is typically located in the lower right
abdomen, specifically in the area known as McBurney's point. This point is located
approximately one-third of the distance from the anterior superior iliac spine (the
bony prominence of the hip) to the umbilicus (belly button), on the right side.
ANATOMY AND PHYSIOLOGY OF THE APPENDIX
The appendix is a small, finger-shaped pouch
located near the junction of the small and large
intestines in the lower right abdomen. While
traditionally considered a vestigial organ with no
significant function, recent research suggests it
may play a role in immune function and gut
health. The appendix contains lymphoid tissue,
including lymphoid follicles, which contribute to
the body's immune system by producing white
blood cells called lymphocytes. Additionally, the
appendix may serve as a reservoir for beneficial
gut bacteria, aiding in digestion and immune function. Despite its potential
immunological role, the appendix can become inflamed and infected, a condition
known as appendicitis, which requires surgical removal to prevent complications
such as rupture and peritonitis.
INDICATIONS
Appendectomy is indicated for acute appendicitis, characterized by symptoms such
as abdominal pain, nausea, and fever, often accompanied by diagnostic findings of
inflammation or perforation of the appendix. Additionally, recurrent or chronic
appendicitis, suspected appendiceal tumors, and perforated appendix necessitate
surgical intervention to prevent complications and alleviate symptoms.
RISKS
The risks associated with untreated appendicitis are much more severe than those
associated with an appendectomy.
Risks of anesthesia and surgery in general include:
Reactions to medicines
Problems breathing
Bleeding, blood clots, or infection
Risks associated with surgery include:
Buildup of pus (abscess), which may need draining and antibiotics
Infection of the incision
Bleeding
Infection and redness and swelling (inflammation) of the belly that can occur if
the appendix bursts during surgery (peritonitis)
Blocked bowels
Injury to nearby organs
CONTRAINDICATIONS
Contraindications for appendectomy are relatively few but include:
Resolved Appendicitis Symptoms: Surgery may not be necessary if
symptoms have resolved and there are no signs of ongoing inflammation.
Severe Coexisting Medical Conditions: Surgery may be contraindicated for
individuals with severe underlying medical conditions due to increased risks.
Pregnancy: Appendectomy during pregnancy is possible but must consider
risks to both mother and fetus, with conservative management sometimes
preferred.
Localized Abscess or Phlegmon: Surgery may be deferred if there's a
localized abscess, with nonsurgical management considered initially.
High Surgical Risk: Appendectomy may be contraindicated for individuals at
high surgical risk, with conservative management and monitoring preferred.
SURGICAL INSTRUMENTS USED
Kelly Curve/Straight Clamp: These clamps are used to grasp and manipulate
tissues, such as the appendix or surrounding structures, allowing for better
visualization and control during dissection.
Straight Clamp: Similar to the Kelly clamp, straight clamps are utilized to grasp
tissues securely, facilitating tissue manipulation and hemostasis as needed
during the procedure.
Babcock: Babcock forceps are atraumatic, used to gently grasp delicate tissues
like the appendix without causing damage. They assist in maneuvering and
isolating structures during dissection.
Ovum Forceps/Sponge Stick: Ovum forceps, also known as sponge sticks, are
used to hold and manipulate surgical sponges or gauze, aiding in the removal of
blood and fluids from the surgical site while maintaining a clear field of view.
Scalpel: The scalpel is used to make the initial incision in the skin and underlying
tissues, providing access to the abdominal cavity for the surgical team.
Tissue Forceps: These forceps are used to grasp and manipulate various
tissues within the surgical field, assisting in tissue dissection, retraction, and
hemostasis as required during the procedure.
Metzenbaum: Metzenbaum scissors are delicate, curved surgical scissors
designed for precise tissue dissection and cutting, particularly useful in dissecting
delicate tissues near vital structures.
Mayo Scissors: Mayo scissors are heavy-duty scissors used for cutting tough
tissues, such as fascia and muscle, during the surgical procedure, facilitating
access to deeper structures.
Mixter: Mixter forceps are commonly used for grasping and manipulating tissues,
particularly during blunt dissection and exploration of the surgical field.
Needle Holder: Needle holders are used to grasp and manipulate surgical
needles during suturing, facilitating precise and controlled needle placement for
wound closure.
Army Navy: These retractors are employed to hold back the edges of the
incision, providing optimal exposure and access to the surgical site for the
surgical team.
Richardson: Richardson retractors are commonly used to hold back the edges
of the incision, providing a clear view and access to the surgical field, particularly
in deep or narrow spaces.
Deaver: Deaver retractors are large, curved instruments used to retract and hold
back deeper tissues and organs, providing optimal exposure and access during
the surgical procedure.
Cherries: Used for surgical training simulations to practice delicate tissue
manipulation and handling skills, aiding in the development of surgical techniques
before performing procedures on patients.
Rolled Gauze: Essential for surgical dressings and wound care, rolled gauze is
applied to control bleeding, pack wound cavities, absorb fluids, and provide
support or padding around the surgical site during an appendectomy.
PREPARATION AND MANAGEMENT
Appendectomy is done using either:
Spinal Anesthesia – Medicine is administered into the back to induce
numbness below the waist, supplemented by a sedative to induce
drowsiness.
General Anesthesia – Patient will be asleep and will not feel any pain during
the surgery.
Preoperative Management: Patients undergo medical evaluation to confirm
appendicitis and assess health. They fast from midnight. Surgeons discuss risks,
benefits, and obtain consent. Antibiotics and anti-nausea meds may be given.
Surgical sites are cleansed, and patients may meet with an anesthesiologist.
Hydration is maintained, and post-op plans are discussed.
Intraoperative Management: Patients receive anesthesia, and surgery is performed
(open or laparoscopic). The appendix is removed, precautions taken to prevent
infection, and incisions closed.
Postoperative Management: Patients are monitored post-surgery. Pain
management and gradual resumption of oral intake and mobility are encouraged.
Intravenous fluids may be given, antibiotics continued, and patients educated about
potential complications. Discharge occurs with instructions for follow-up care,
medication, and activity restrictions.
REFERENCES:
Appendectomy https://medlineplus.gov/ency/article/002921.htm
Appendectomy https://emedicine.medscape.com/article/195778
