Appendectomy

Appendectomy is the surgical removal of the appendix ( vermiform appendix ). The in common parlance mistakenly referred to as appendix removal surgery is usually used for the treatment of appendicitis ( colloquially appendicitis ). The names of appendicitis and appendectomy are not medically accurate, as it is in each case by the vermiform appendix, which is inflamed and is removed. The operation is used not only in inflammatory diseases and tumors, such as the appendix carcinoid. The first successful appendectomy was performed in 1735 by accident by Claudius Amyand ( surgeon of George II in London ) on an eleven year old boy.

  • 6.1 Advantages of the laparoscopic procedure
  • 6.2 Advantages of the conventional method

History

1735 succeeded the French surgeon Claudius Aymand the first successful Blinddarmopperation. Surgery was performed at St. George 's Hospital in London.

Indication

The clinical suspicion of acute appendicitis is the most common and most urgent indication for appendectomy. Recurrent, atypical right-sided lower abdominal pain lead to exclusion of any other disease ( salpingitis, cystitis, etc. ) is also an appendectomy indication. Tumorous changes ( appendiceal carcinoid ) are often symptom-free and fall to at laparotomy or laparoscopy for other reasons. You then provide also an indication for appendectomy represents the prophylactic appendectomy for example, before long stays in medically underserved areas is controversial, but still performed occasionally.

Principle of operation

The blood supply of the vermiform appendix about the so-called mesoappendix (formerly mesentery ) is interrupted by ligation or electrocoagulation and divided. The appendix is then attached to the base, ie the transition from the appendix to the cecum ( cecum ) inhibited and deposed. The ligation is carried out in the conventional method using absorbable suture, the laparoscopic approach, this is used as a so-called " Roeder - loop " alternative is also the use of a truck in question. The stump can be invaginated by a so-called purse-string suture in the cecum or leave after disinfection. In highly inflammatory findings, a target drainage is introduced.

Vermiform appendix after separation with the forklift

Cecum at the end of the operation

Access routes

Access is via laparotomy or laparoscopy. One speaks therefore of conventional and laparoscopic appendectomy. The latter was first performed worldwide on September 13, 1980 at the Christian -Albrechts -University of Kiel by the gynecologist Kurt Semm. Yet in 1981 urged the president of the German Society of Surgery for a lecture on laparoscopic appendectomy in a letter to the Board of the German Society of Gynecology and Obstetrics, Kurt Semm to withdraw the approval. A scientific paper on laparoscopic appendectomy in the American Journal of Obstetrics and Gynecology was on the grounds that the technique is unethical rejected.

Conventional access

Typical:

  • Change interface after McBurney: Short bevel cut on the right lower abdomen, opening the fascia, the fibers of the abdominal muscles ( rectus abdominis, external oblique, internal oblique ) are forced apart in their course, Representing and opening the peritoneum. Was also called " bikini cut" in the vernacular.
  • Pararectalschnitt: as above, but will be discussed at the lateral boundary of the rectus abdominis.
  • Transrectalschnitt: longitudinal section on the right lower abdomen, longitudinal splitting of the rectus abdominis. This section is preferred in obese patients or highly acute / unclear findings, since it can be extended at will.

Atypical:

  • Lower abdominal midline incision (medial laparotomy ) In case of unclear diagnosis or likely severe adhesions.

Laparoscopic access

Access for optics is usually created just below the navel with a 10 mm skin incision. Two research approaches ( 5 mm and 10 mm ) are applied on the lower abdomen to the upper border of pubic hair.

Risks and Complications

Typical complications and thus risks of appendectomy are: insufficiency of the appendiceal stump (that is not holding the seam) with subsequent abscess or even purulent peritonitis ( peritonitis); Wound infection (especially with perforation of the appendix by intraoperative spread of pathogens in the abdominal wall ), adhesions, sometimes with the result of intestinal obstruction ( ileus ), ( re-) bleeding, injury to bowel, ureter, or other adjacent organs, incisional hernia.

Comparison of conventional / laparoscopic procedure

Advantages of the laparoscopic procedure

  • Cosmetically outnumber
  • Possibility of diagnostics of the entire abdomen, especially hedge the differential diagnosis of salpingitis, ovarian cyst
  • Lower rate of wound healing
  • Faster recovery
  • Less frequent occurrence of incisional hernia ( incisional hernias )

Advantages of the conventional method

  • Lower apparatus required
  • Easier way of engaging extension

The cost of the two methods differ - when using the Roeder loop ( laparoscopically ) - only marginally; the laparoscopic instruments in every hospital in the German-speaking area available.

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