Perioperative management - Appendectomy, open - general and visceral surgery
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Indication
- Any clinical suspicion of appendicitis.
- An unremarkable ultrasound study and normal inflammation parameters do not rule out this diagnosis!
- In young women laparoscopic appendectomy should be performed (particularly in the context of possible gynecologic differential diagnoses).
- Laparoscopy whenever the clinical situation is marked and other differential diagnoses (e.g., sigmoid diverticulitis, gynecologic causes, etc.) cannot be ruled out.
Contraindication
- Acute episode of Crohn disease with so-called "concomitant appendicitis". Initial medical treatment, surgery only in case of further clinical deterioration.
Caution: Inflammatory changes at the cecum increase residual stump rupture rate and secondary fistula formation. - So called "concomitant appendectomy" during other abdominal procedures.
- Acute episode of Crohn disease with so-called "concomitant appendicitis". Initial medical treatment, surgery only in case of further clinical deterioration.
Preoperative diagnostic work-up
- Mandatory: Medical history, clinical examination, lab tests.
- Ultrasonography is optional (operator-dependent).
- Gynecologic consultation in women and whenever medical history demonstrates possible gynecologic causes (e.g., adnexitis)
- CT study in "acute abdomen" if diagnosis is still uncertain after all other studies (clinical picture, lab panel, ultrasound). [NG CS et al. BMJ. 2000; 325: 1387]
Special preparation
None
Informed consent
- Secondary healing
- Intraabdominal abscess requiring revision or percutaneous drainage
- Postoperative ileus
- Adhesions
- Stump rupture
- Injury to other segments of the bowel, vessels, nerves (e.g., ilioinguinal nerve on the internal oblique)
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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