The surgery for appendicitis

An appendicitis does not always have to be treated with surgery. In principle, a waiting, conservative treatment is possible with bed rest, the administration of antibiotics, laboratory chemical controls and a temporary renunciation of food (food leave). This procedure is intended to avoid unnecessary surgical interventions, but there is always the risk of a worsening and further progression (aggravation) of the disease.

If, however, acute appendicitis cannot be ruled out with sufficient certainty, the indication for surgery is generally given. Of course, an operation under general anaesthesia is always accompanied by a risk of complications. However, this risk is considered to be lower than the removal of the appendix in case of acute appendicitis.

In almost one third of all cases of appendectomy, a perforation (rupture) of the appendix into the free abdominal cavity is caused. This results in a tearing of the intestinal walls of the appendix due to the death of tissue (necrosis). The intestinal contents flooded with germs can thus pour into the peritoneal cavity, where it can cause peritonitis, which is often life-threatening.

The occurrence of such peritonitis without surgery is associated with a mortality rate (lethality) of up to 30 percent, which is why the indication for surgery in the case of acute appendicitis is very generously set in order to prevent this consequential damage. Surgery for appendicitis is called appendectomy, which refers to the removal of the appendix appendix appendix. There are two different surgical techniques, a distinction is made between conventional and laparoscopic appendectomy.

In conventional surgery, the surgical approach is via a so-called alternating incision on the right lower abdomen. After a short oblique incision of the skin, the fibres of the abdominal muscles are first forced apart according to the direction of their fibres and the peritoneum is opened. Opening the abdominal cavity via an abdominal incision is called laparotomy.

The surgeon has direct access to the internal organs and can perform the operation under direct vision. The second surgical technique differs from this, which is called laparoscopy or minimally invasive surgery. For laparoscopy, only a minimal skin incision (about one centimeter long) is made just below the navel and two even smaller so-called “working accesses” are made in the lower abdomen.

In this way, special devices, to which a video camera and a light source are connected, can be inserted into the abdominal cavity according to the keyhole principle and the operation can be performed. The smaller incisions and injuries caused by this access usually result in less pain after the operation and also in a faster recovery. Compared to the conventional method, laparoscopy results in fewer scar fractures (scar hernias) and the rate of wound healing disorders is lower.

A disadvantage in some cases is the reduced clarity of the surgical field and the delayed access in the event of a threatening complication such as heavy bleeding in the surgical area. In addition, the need for equipment is lower in conventional surgery (the costs of the two procedures differ only minimally). After access to the inflamed appendix has been created, the surgical procedure is very similar in both surgical techniques.

First, the blood supply to the appendix is interrupted and the appendix is severed and removed at the transition to the appendix. If there is a severe inflammation of the appendix, a drainage can be temporarily applied to drain wound secretions from the abdominal cavity. Typical complications associated with an appendectomy are, in addition to the general risks associated with anaesthesia, for example a defect (insufficiency) in the suture to the intestine, which can lead to a purulent peritonitis or an abscess (pus cavity).

In addition, wound infections can occur, especially if the appendix ruptures and the resulting pathogens are carried into the peritoneal cavity. There is a risk of adhesions, which can occasionally lead to intestinal obstruction (ileus). In addition, the operation may cause bleeding and injury to the ureter, intestine or other neighbouring organs.

The prospect of recovery (prognosis) is very good with an appendectomy. If the appendicitis is not perforated (ruptured), the mortality rate is less than 0.001 percent and is therefore very low. However, if the inflammation has already perforated, the mortality rate is about one percent due to the increased risk of complications.

If acute appendicitis is suspected, surgery should be performed as early as possible. Surgery should be performed within about 48 hours in order to prevent the inflammation from breaking through as much as possible. In most cases, there are no further risks for those affected if surgery is performed within the first 48 hours of the disease. and therapy of appendicitis