Appendectomy surgery refers to the removal of a suppurated, perforated, or inflamed appendix, followed by suturing and embedding the stump, either through laparotomy or laparoscopy. This procedure is a common surgical procedure that is relatively simple to perform, requires a small incision, and can effectively relieve the patient’s abdominal pain and other discomfort. It should be noted that appendectomy surgery may lead to complications such as incisional fecal fistula, incisional infection, pelvic infection, and intra-abdominal bleeding. Therefore, patients are advised to seek treatment at a reputable medical institution and follow the doctor’s instructions for postoperative care to reduce the risk of the above-mentioned conditions.
Applicable people
Appendicitis surgery is suitable for patients with purulent appendicitis and perforated appendix. In addition, patients with appendicitis who have failed conservative treatment can also undergo appendicitis surgery.
Taboo groups
1. The patient’s condition is controllable and belongs to the early stage of simple appendicitis or acute appendicitis.
2. The patient does not accept surgical treatment.
3. The patient’s general condition is poor or objective conditions do not allow surgical treatment.
4. The patient has other serious diseases and contraindications for surgery.
Technical/surgical risks
1. Fecal fistula: This condition is primarily caused by severe inflammation at the base of the appendix and edema within the cecal wall, which forcibly encases the appendix stump. Patients typically experience pain, heat, swelling, and redness at the incision site 3-5 days after surgery. Upon incision, fecal discharge with a strong odor is detected. With dressing changes, recovery is typically achieved in approximately 12 days.
2. Wound infection: This is primarily caused by contamination of the incision during surgery, resulting in hematoma or foreign matter. Most patients with wound infection suffer from perforated or suppurative appendicitis. Once infection is detected, incision and drainage should be performed proactively, and antibiotics should be used appropriately.
3. Pelvic infection: Pelvic infection typically presents with symptoms such as increased bowel movement, a feeling of urgency, or rectal irritation. Examination of the anterior rectal wall may reveal a palpable mass. In such cases, rectal drainage can be performed, with effective placement of a drainage strip, and antibiotics should be administered proactively.
4. Intraperitoneal bleeding: Intraperitoneal bleeding is generally caused by the detachment of the mesoappendix ligature. Effective drainage should be performed on the day of surgery. If the bleeding is arterial, double mesoappendix ligation should be performed. With this treatment, the patient generally recovers within seven days.
5. Incisional hernia: This complication is more common in older men. A few months after an incisional hernia occurs, a retractable mass may develop at the incision site. In this case, doctors may administer conservative treatment with an abdominal bandage.
6. Adhesive intestinal obstruction: The main cause is the patient’s severe appendicitis, which then affects the adjacent intestine, eventually causing fibrin exudation and the formation of infectious peripheral intestinal adhesions. During the operation, the doctor’s rough operation, which then damages the patient’s intestines and serosal surface, or because the thread is too long, can also cause intestinal obstruction. In addition, if the drainage tube is too hard, too thick, or left in place for too long, it can also cause adhesive intestinal obstruction. In this case, the doctor generally performs conservative or surgical treatment.
7. Appendicitis: If the appendix is not removed sufficiently or completely, stump inflammation may occur after the operation. The patient will experience pain in the right lower abdomen, and the physical examination signs will be similar to those of appendicitis.
Postoperative care
After appendicitis surgery, attention should be paid to local care, drug management, diet conditioning and lifestyle behavior management.
1. Local care: Keep the incision clean and dry, and pay attention to whether there is bleeding. If there is bleeding, the dressing should be changed in time.
2. Medication management: Use antibiotics as directed by your doctor to prevent infection. If the abdominal incision is painful, take analgesics as directed by your doctor.
3. Diet adjustment: You can drink water appropriately after the gas is discharged. If there is no discomfort, you can gradually add liquid food with less residue, such as rice paste and rice porridge, and then change to lighter soft food, and then gradually return to a normal diet.
4. Behavioral management: Rest in a semi-recumbent position for 6 hours after surgery. Afterwards, you can get out of bed and move around as needed, but avoid strenuous exercise for a short period of time. If pain, redness, swelling, abdominal distension, abdominal pain, vomiting, or nausea occur after surgery, you should go to the hospital for a follow-up examination in a timely manner.
Preoperative precautions
1. Communicate with the doctor to understand the complete process, possible effects and risks of appendicitis surgery, and sign the informed consent form for anesthesia and surgery.
2. Complete preoperative examinations, such as blood routine, urine routine, coagulation function, liver and kidney function, electrocardiogram, abdominal ultrasound, chest X-ray, upright abdominal X-ray, etc., to rule out surgical contraindications.
3. Do not eat or drink for 6 hours before the operation and do not drink water for 4 hours before the operation.
4. Cooperate with the doctor to remove hair in the surgical area and place a urinary catheter.
Surgical procedure
Appendicitis surgery can be performed under laparotomy or laparoscopy. Here we take laparotomy for appendicitis surgery as an example. The operation process mainly includes making an incision, exposing the appendix, removing the appendix, suturing and other steps.