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.
INDICATIONS
Acute Appendicitis
Appendiceal Abscess
Peritonitis
Ruptured Appendix
Chronic Appendicitis
Appendix Mass
Suspected Tumors in the Appendix
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.
LAPAROSCOPIC CHOLECYSTECTOMY
A cholecystectomy (koh-luh-sis-TEK-tuh-me) is a surgery to
remove the gallbladder. The gallbladder is a pear-shaped
organ that sits just below the liver on the upper right side of
the abdomen. The gallbladder collects and stores a digestive
fluid made in the liver called bile. A cholecystectomy is a
common surgery. It is a safe operation and usually carries
only a small risk of complications. In most people this surgery
is done using small incisions, and you can go home the
same day of your cholecystectomy. A cholecystectomy is
usually done by inserting a tiny video camera and special
tools through several small incisions to see inside your
abdomen and remove the gallbladder. This is called a
laparoscopic cholecystectomy.
INDICATIONS
Gallstones in the gallbladder that are causing
symptoms, called cholelithiasis.
Gallstones in the bile duct, called choledocholithiasis.
Gallbladder inflammation, called cholecystitis.
Large gallbladder polyps, which can turn cancerous.
Pancreas inflammation, called pancreatitis, from
gallstones.
Concern for cancer of the gallbladder.
CONTRAINDICATIONS
Empyema of the gallbladder
Gangrenous cholecystitis
Coagulopathy
Portal hypertension
Peritonitis
PRESSURE AND FLOW RATE
In a laparoscopic cholecystectomy, the standard pressure
used to inflate the abdominal cavity with carbon dioxide
gas (creating a pneumoperitoneum) is typically between
12-15 mmHg, with a flow rate adjusted to maintain this
pressure while providing adequate visualization of the
surgical field; the goal is to use the lowest pressure
possible to achieve proper exposure while minimizing
potential complications from high intra-abdominal
pressure.
SIGNIFICANCE OF PLAIN LR (LACTATED RINGER’S) SOLUTION IN POST-OP PATIENTS
While both Ringer's Lactate and Normal Saline are intravenous fluids used to treat
dehydration, Ringer's Lactate is often considered a more balanced solution due to its closer
electrolyte composition to human blood, making it potentially preferable for situations where large fluid
volumes need to be replaced, particularly in cases of trauma or severe blood loss, as it is less likely to
cause metabolic acidosis compared to normal saline which has a higher chloride content; however,
normal saline might be preferred in specific situations like when there are concerns about potential
interactions with certain medications or in patients with certain medical conditions like congestive
heart failure.
REFERENCES:
Appendectomy https://medlineplus.gov/ency/article/002921.htm
Appendectomy https://emedicine.medscape.com/article/195778
Cholecystectomy Cholecystectomy (gallbladder removal) - Mayo Clinic
