Appendectomy (Appendectomy): the Conventional Method of Surgery

Girls and women of childbearing age in particular benefit from the laparoscopic method. In contrast, the conventional method has advantages when the appendix is very severely altered, because it often cannot be removed laparoscopically, or only with great difficulty.

In this conventional method, the abdominal cavity is opened through a small incision in the right lower abdomen. The lower pole of the appendix is then sought, where the appendix is usually found. In some cases there are problems in finding it, in which case the incision may need to be widened. The physician clamps the feeding vessels and removes the appendix. The remaining stump is countersunk by means of a special suture, the so-called tobacco bag suture, and secured with a second suture.

The surgeon then sutures the abdominal wall in layers, and occasionally a drain is placed in the wound area to allow drainage of blood and wound secretions. If there is an abscess (pus cavity) in the appendix area, it is opened and a tube is inserted to drain the wound secretions to the outside.

“Notes”: procedure without incisions

“Notes” is the generic term for a technology that is already being used sporadically in some countries – it stands for “Natural Orifice Transluminal Endoscopic Surgery,” which is an endoscopic technique that uses natural orifices to access large internal body cavities, such as the abdominal cavity, and operate on organs inside. As reported by Ärztezeitung in its online edition on Oct. 22, Berlin surgeons said they were the first in Germany to remove a kidney from a patient via the vagina.

The aim was to spare the 44-year-old woman an abdominal incision, wound pain and visible external scars. The woman was able to return home after only six days; normally, such an operation requires 17 days in the hospital. Gall bladders have previously been removed via the vagina in Germany.

Controversial method

However, not all physicians are convinced of the method: so a higher risk of infection is given, because to pull the diseased organ from the body, an incision would still have to be made from the inside in the vaginal area. Since the stomach and large intestine are extremely germ-rich environments, the risk of peritonitis is greater with an incision inside the body than outside on the abdominal wall.

The proof of an advantage for patients could only be shown in long-term studies. In Germany, gallbladder removals, appendectomies, and full-wall gastric resections have been performed in this way in humans to date. A dozen other operations have been tested in animals.