acute or chronic appendicitis;
condition after appendiceal infiltration;
the presence of neoplasms of the appendix.

Emergency surgery is usually performed no later than 1 hour after an accurate diagnosis is made. If we are talking about a previous appendiceal infiltrate or a chronic course of the disease, surgical intervention is performed as planned (within 2 months to six months).

The operation may be delayed for some time in patients who are in a state of intoxication, preschool children, as well as in elderly patients. In acute appendicitis, there are no contraindications to appendectomy. The only condition when surgery cannot be performed is late agony.

If we are talking about a planned operation, the patient should be carefully examined. Direct contraindications to radical surgery may include acute and chronic pathologies of the heart, kidneys, lungs, and liver.

Preparing for surgery

An appendectomy can be performed as an emergency or planned surgical procedure. It all depends on what stage the inflammatory process is at, where the appendix is localized, and what size the abscess is, if any.

Abdominal surgery is started only when an accurate diagnosis is established. Emergency surgery is performed in the presence of life-threatening symptoms (peritonitis and increasing manifestations of sepsis).

If the patient asked for help himself, not urgently, it is possible to observe the patient and more carefully prepare for the upcoming appendectomy. It is advisable that the patient undergoes the full range of necessary diagnostic tests; this will make it possible to minimize the risk of most complications and select the optimal option for pain relief.

Standard preparation protocol

On the eve of an appendectomy, it is necessary to perform a number of mandatory preparatory manipulations and procedures:

Examine the cardiovascular system (using an ECG);
Choose the most appropriate anesthesia option;
Prepare the abdominal area , who will undergo surgery (shaving the hair on the surgical site);
Conduct a series of laboratory tests (general blood and urine analysis, coagulogram, HIV test, syphilis, hepatitis);
Conduct instrumental studies (ultrasound of the appendix, abdominal organs).

Treatment methods

The traditional scenario for the operation to remove the appendix is carried out by creating a small incision not exceeding 12 centimeters. The entire procedure can be divided into several stages:

Introducing the patient into a state of anesthesia. Today, removal of the appendix is most often performed under general anesthesia. If there are contraindications to general anesthesia, anesthesia is performed using the tight infiltration method or through conduction blockade;
After this, the surgeon dissects the abdominal wall layer by layer, this allows you to avoid postoperative complications associated with damage to nerve endings, as well as respond in a timely manner to the sudden occurrence of bleeding;
The muscles, like the edges of the surgical wound, are separated with blunt surgical instruments;
After opening the internal space of the abdominal cavity, the doctor carefully examines the abdominal wall itself, assesses the condition of neighboring organs and begins to remove the intestinal loops, behind which the appendix itself is located;
Next, the surgeon removes the appendix and sutures the surgical wound. First, the inflamed process is isolated from other tissues using a clamp and ligature;
The surgeon places a purse-string suture on the stump (the edges of the sutures are inside the stump);
After completing all surgical procedures inside the abdominal cavity, the surgeon forms external sutures. The peritoneal walls are usually held together using self-absorbable suture material. The surgeon places from 8 to 12 stitches, using synthetic or silk threads;
The external postoperative suture must be removed 1 - 2 weeks after surgery.

Laparoscopy

Laparoscopic surgery to remove the appendix is considered one of the most popular methods of removing the appendix. Surgical intervention is performed through micro-incisions. Using high-tech endoscopic equipment, the surgeon gives himself access to the abdominal cavity to the inflamed appendix.

At the initial stage of the operation, a gas mixture is introduced into the abdominal cavity. A miniature camera is inserted into one of the punctures, which will transmit the image to the monitor. The surgeon will be able to see everything that happens in the closed abdominal cavity. Then all the same manipulations occur as with the classic method of surgical removal of the appendix.

Minimally invasive techniques for removing the appendix

Despite the fact that classic appedectomy and laparoscopic removal of the appendix of the cecum are used quite often, the popularity of minimally invasive techniques is increasing every day. We are talking about the following forms of surgical intervention:

transgastric appendectomy. It is performed without external incisions. To gain access to the tissues of the cecum and enter the abdominal cavity, a system of flexible instruments is used. The devices are inserted through the digestive tract, passing through the desired area of the intestine;
transvaginal appendectomy. Access to the source of inflammation is carried out along an ascending route through a micro-incision in the vaginal wall. When choosing this method for removing the appendix, the location of the lesion plays a significant role.

Operations of this type make it possible to prevent complications associated with direct tissue trauma. They cannot be carried out if peritonitis is suspected, in the presence of multiple large foci with inflammation, or when the patient has manifestations of sepsis.

Early recovery period

After the operation is completed, the patient is observed for several days by the operating surgeon. Sutures are removed 7-10 days after surgery.

Early postoperative rehabilitation includes the following points:

Detoxification of the body (in this case, activities are carried out both on the first day after surgery and in the following days);
Following a strict diet;
Restoring the functional potential of the intestines and bladder.

In the postoperative period, the patient may be prescribed medications (antibiotics, analgesics). Particular attention is paid to the prevention of constipation (for this purpose, a special diet and laxatives are prescribed).

Appendectomy, laparoscopy and other minimally invasive methods for removing appendicitis. Appendectomy Planned surgery for appendicitis

Appendectomy is a common operation performed in the abdominal area. Another name for surgical procedures is appendectomy.

Now the pathology is treated in two ways:

Carrying out conservative therapy. Treatment is carried out using medications.
Complete surgical removal of the inflamed area.

Often, after taking medication, the appendage has to be removed.

Surgery is performed using two main methods:

A full longitudinal incision is made on the side of the abdomen, in the area where the appendix is located.
Three punctures are made where the organ is located.

There is also a method with one puncture and removal through the mouth or vagina. Gradually, these methods were abandoned in favor of the above.

Pregnant women.
Children under 6 years old.

Young patients cannot clearly and correctly explain their condition, the nature of the pain, and there is also a weak severity of the pain syndrome. Therefore, diagnosis is difficult.

In pregnant women, constant constipation, changes and compression of organs by the growing uterus lead to blocking of the appendix and the occurrence of inflammation. Decreased immunity due to hormonal changes.

The main reason indicating the need for surgery is an acute form of inflammation of the appendix or. Other factors that bring the patient to the operating table:

Increased symptoms of body poisoning by products of the inflammatory process.
Violation of the integrity of the appendix and penetration of purulent products into the internal organs, the development of peritonitis.
Increased risk of rupture.

Depending on the patient’s condition and the stage of the disease, the operation is performed in two ways:

According to plan.
In an emergency or urgent form.

Planned

Surgical intervention is used if removal is impossible or prohibited. This is usually carried out in the presence of infiltration. Initially, drug treatment is performed to relieve the acute form, and then cutting is prescribed when there is no threat to the health and life of the patient.

Urgent

The acute form of the disease provokes emergency removal. Occurs when an organ ruptures and peritonitis.

The development of chronic appendicitis is associated with the periodic occurrence of a discomfort state. Its treatment is carried out using medications and surgery. The doctor chooses the methods. If symptoms appear infrequently and not intensely, they try to treat with medications.

Diagnostic examination

Before removing an organ, an examination is carried out and tests are taken. This is done to exclude other pathologies to confirm the diagnosis.

Inspection

The surgeon first examines the patient to identify symptoms of appendicitis. The procedure involves palpation and tapping the area of the body where it hurts, and preliminary determination of the location of the appendix. Attention is paid to what position the patient occupies. A visual examination of the condition of the abdomen is performed. At the site of inflammation, the skin will be raised and inflamed.

Blood and urine tests are taken to determine the degree of inflammation and rule out diseases with similar symptoms.

Instrumental examination

The use of equipment is necessary to make an accurate diagnosis and determine the location of the appendix:

Ultrasound examination.
Computed tomography using contrast.

Types of surgery

An appendectomy is the surgical removal of an inflamed organ (appendix). The entire process is cut out, the remains are sutured and hidden inside the cecum.

In surgical practice, two main methods of intervention inside the patient’s body are used:

Laparotomy. An incision is made in the area where the inflamed appendix is located. Open surgery.
Laparoscopy (endoscopy). For removal, small punctures (three) are made in the abdominal area.

The methods have both positive and negative aspects.

Laparotomy

Is the classic way. Laparotomy is the first abdominal operation performed on the appendix. Indications:

The diagnosis was confirmed: acute appendicitis.
The acute form gave complications - peritonitis.
Consequences of an acute illness in the form of an infiltrate that connects the appendix, cecum, small intestine and omentum.
Chronic appendicitis.

Peritonitis and clinical signs of acute illness are indicators for urgent surgery. When there is an infiltrate inside, conservative treatment is used aimed at relieving the inflammatory process. Therapy can take 2-3 months. Then a planned removal is scheduled.

When laparotomy should not be performed:

The patient is in agony.
If the patient independently refuses surgical procedures in writing.
Planned intervention. Dysfunction of the cardiovascular system, breathing, kidneys and liver.

Preparation for the operation does not require special measures. If the patient has a violation of the water-salt balance or peritonitis has developed inside, then liquids and broad-spectrum antibiotics enter the body through intravenous administration.

Progress of the operation:

Introduction of anesthetic solution. General anesthesia is given. The solution enters the body either through injection into a vein or through an inhalation device. It is extremely rare that anesthesia is administered through the spinal canal.
The site of the future operation is treated with antiseptic agents. Iodine in alcohol, betadine, and alcohol are used as disinfectants.
An incision is made in the area where the appendicitis is located. Penetration inside is carried out by cutting tissue layer by layer.
A visual inspection of the internal contents is carried out. The appendix rises above the organs.
The process is cut off (resection is performed). In this case, sutures are placed at the site of the incision of the mesentery and appendix.
Then excess fluid is removed, a drainage system is installed (tubes for removing inflammation products), and sanitation is carried out with tampons and electric suction.
The incision in the peritoneum is sutured with special threads. Access is closed by layer-by-layer stitching of tissues in the reverse order of penetration.

Access to the peritoneum is carried out according to the following options:

Volkovich-Dyakonov method, oblique incision.
Lenander's method. Longitudinal section.
Access via transverse incision.

Drainage is performed in several cases:

Rupture of the appendix and development of peritonitis.
Formation of pus at the site of the operation.
Inflammation develops in the retroperitoneal tissue.
Incomplete blockage of blood vessels damaged as a result of surgery. Incomplete hemostasis of arteries.
There are no clear indications for cutting out an inflamed organ.
There was an incomplete immersion of the remnants of the process into the body of the cecum.

The drainage is removed after 2-3 days if healing proceeds without complications.

The cutting process during laparotomy takes from 40 minutes to one hour. If complications are present (adhesive disease, incorrect location of the organ), then the surgical process lasts from two to three hours. The recovery process lasts up to a week. It is recommended to remain in bed for 2-3 days from the day of surgery. External sutures are removed on the 7th or 10th day.

Laparoscopy

There is another method of removal, which is less traumatic - laparoscopy. It is limited in use and has both indications and contraindications for cutting.

When is the use of minimally invasive appendix removal indicated:

The first day of development of an acute form of the disease or a mild form of the disease.
The disease is chronic.
The child develops acute appendicitis.
Concomitant diseases of the patient that provoke poor wound healing and subsequent suppuration. These include diabetes and excess weight.
Written statement from the patient regarding the use of laparoscopic appendectomy.

Let's consider cases when the use of the method is prohibited or undesirable.

General contraindications:

Last months of pregnancy.
Acute cardiovascular diseases. Failure or infarction.
Lung dysfunction causing respiratory failure.
Poor blood clotting.
General anesthesia is not recommended.

Local contraindications:

Appendicitis takes longer to develop than a day.
Development of peritonitis.
Areas of purulent processes with clear or blurred edges.
Adhesive disease in the peritoneum.
Access to the appendix is difficult due to its incorrect location.
Around the organ, small intestine and large intestine there are inflamed tissues with a changed structure - infiltrate.

The removal operation is carried out without special preparation. In case of appendicitis, the process takes a minimum of time: an IV containing saline solution is installed, antibiotics with a wide spectrum of action are administered. In the operating room, a tube containing an anesthetic solution is inserted into the patient, which is administered by inhalation. Laparoscopy is performed only under general anesthesia.

Appendicitis is removed without an incision, using special medical instruments:

Laparoscope.
A tube for pumping carbon dioxide, called an insufflator.
Laser for cutting off the appendage.
A monitor that allows you to monitor the progress of the operation and examine the internal situation.

Laparoscopy takes place in several stages:

The site of future intervention is being prepared. Holes are made in the abdomen for insertion of medical instruments.
The abdominal cavity is examined from the inside. Carbon dioxide is released into the abdominal cavity, which allows for a better inspection.
Once located, the appendix is fixed at the center or end. Then the cutting is performed: first of the mesentery, and then of the organ itself. After the excised organ, stumps of the process and connective tissue remain. Sutures are placed at the cut-off sites: separately on the mesentery, separately on the appendix. The organ is brought out using a trocar. The procedure is performed carefully and professionally.
The pus and other fluids that appeared during the cutting process are removed. If necessary, drainage is installed.
Sutures are placed on the holes where the instruments were.

If at the examination stage complications were identified that are part of the contraindications to laparoscopy, then the instruments are removed and a classic cut is performed.

Sometimes after surgery you may need to install drainage hoses:

Signs of developing peritonitis were detected.
The blood vessels continue to bleed.
The surgeon is not completely sure whether the organ was completely removed or whether the resection was incomplete.

The tube is brought out through a puncture on the side.

The duration of the surgical intervention is 30 – 40 minutes. Complications can increase the duration of the procedure to 3 hours.

Once operated on, the recovery process takes 3 days. The drainage system is removed on the second day. Physical activity is allowed after 60 days.

Endoscopic intervention compared to laparotomy has a number of advantages:

Recovery takes place in a short time.
Invisible scars remain on the skin.
After removal, there is virtually no pain.
Minimal trauma to the anterior peritoneum.
During laparoscopy, it is possible to carefully examine the internal contents of the abdominal cavity and identify additional pathological processes.
Intestinal motor activity is quickly restored.
There is no mandatory bed rest.
There are practically no complications after appendicitis.

However, carrying out a minimally invasive method is associated with some difficulties:

Expensive equipment is required.
Medical staff need to be trained.
General anesthesia.
The surgeon loses the ability to sense tactile sensations.
Data is displayed on the monitor in a flat form (two-dimensional space).

Stages of appendectomy ">

Stages of appendectomy.

Appendectomy - removal of the appendix (appendix).

Indications for surgery. The indication for surgery is acute appendicitis, as well as the condition after appendiceal infiltration . In case of acute appendicitis, the operation is performed as an emergency (no later than an hour from the moment of diagnosis); after appendiceal infiltration, surgery is performed as planned (from 2 to 6 months after the acute stage of the disease).

Contraindications. In acute appendicitis, there are no contraindications to appendectomy, with the exception of the agonal state of the patient. When performing a planned operation, contraindications include severe diseases of the heart, lungs, liver, and kidneys.

Types of pain relief. The operation is performed under general anesthesia or local anesthesia.

Performing an operation. Classically, an appendectomy is performed through a small incision in the right lower abdomen (iliac region). The dome of the cecum with the vermiform appendix is brought into the wound. The latter is tied at the base and intersected; its mesentery is also carefully tied with a separate thread and intersected. If at the time of surgery there is a small amount of peritoneal exudate (fluid that occurs during inflammation of the abdominal organs) in the abdominal cavity, it is removed with gauze swabs. When peritoneal exudate spreads to most of the abdominal cavity - the presence of widespread peritonitis - appendectomy is performed from a median laparotomy . Recently, it is possible to perform appendectomy using laparoscopic equipment. In this case, the appendix is removed using special instruments and equipment through separate punctures in the abdominal wall.

Possible complications. Complications during the operation are rare. With the classical method of surgery, technical difficulties may arise due to the atypical location of the appendix in the abdominal cavity. During laparoscopic appendectomy, the location of the appendix does not affect the surgical technique. In the postoperative period, the most common complication is suppuration of the surgical wound of the abdominal wall (with purulent appendicitis with the presence of peritonitis, the frequency of wound suppuration can reach 20%). If the operation is performed laparoscopically, the likelihood of wound suppuration is significantly reduced. A rarer postoperative complication is the formation of inflammatory infiltrates and abscesses (ulcers) in the abdominal cavity; the frequency of these complications with classical and laparoscopic methods is the same.

Discharge from hospital. If appendectomy is performed through an incision in the iliac region and no complications arise, patients are discharged from the hospital 5-7 days after surgery.

Postoperative period. Full functionality is restored within a month. When the operation is performed laparoscopically, patients can be discharged after 2-3 days, and work capacity is restored after 10-14 days.

Treatment of appendicitis always involves surgery. Before surgery, the patient is prescribed preparatory measures: tests are taken, X-rays and ultrasounds are done, and anamnesis is studied. Only after receiving the examination results do they begin appendectomy. There are several varieties of this operation. We will talk about them in more detail in today's article.

What is appendicitis?

This is an acute surgical disease, manifested by pain in the abdomen and symptoms of intoxication. It is characterized by inflammation of the appendix, the appendix. In childhood, it takes an active part in local immunity. However, over time this function is lost. The vermiform appendix becomes a useless formation. Therefore, its removal does not have negative consequences for the body.

Appendicitis is usually diagnosed in young people. The reasons for the development of the inflammatory process are still unknown. Doctors express various assumptions and hypotheses. Despite the apparent simplicity of the diagnosis, identifying it at the initial stage is quite difficult. The pathology is often “masked” as other diseases and has an atypical course. Regardless of the cause of appendicitis, appendectomy is the only treatment option.

Indications for surgery

Appendectomy belongs to the category of interventions that are performed on an emergency basis. In this case, the main indication for surgery is an acute inflammatory process. Planned surgical intervention is prescribed in the case of a pathology in which the appendix merges with areas of the intestine, omentum or peritoneum. After it subsides (approximately 2-3 months from the onset of the disease), surgery is performed. If the symptoms of intoxication increase spontaneously, an abscess ruptures followed by peritonitis, the patient needs emergency intervention.

Preparation for the procedure

The appendectomy operation lasts no more than an hour. During the intervention, a general or a specific option is used. The choice of a specific option depends on the age of the patient, his condition and the presence of concomitant pathologies. For example, general anesthesia is recommended for children and overweight people, as well as for mental illness or nervous overexcitation. For thinner patients, local anesthesia is preferred. Pregnant women also fall into this category, since general anesthesia has a negative effect on the fetus.

An appendectomy is an emergency operation. It does not allow enough time to prepare the patient. Therefore, before the intervention, a minimum number of examinations are prescribed: blood and urine tests, ultrasound, x-rays. To exclude pathologies of the appendages, women are additionally recommended to consult a gynecologist.

Immediately before the operation, a catheter is inserted into the bladder and gastric lavage is performed. For constipation, an enema is indicated. The entire preparatory stage lasts no more than 2 hours. After confirming the diagnosis, the doctor also determines the specific intervention option. Today, this operation is possible in several ways (traditional, laparoscopic and transluminal).

Each of them will be discussed in detail below.

Traditional appendectomy

Treatment of appendicitis using this method is usually divided into two parts. First, the doctor obtains surgical access, and then proceeds to the procedure for removing the cecum. The intervention lasts no more than one hour.

To gain access to the inflamed process, the surgeon makes an incision in the skin on the right. Its length is usually 7 cm. The McBurney point is the reference point. After cutting the skin and fatty tissue, the doctor penetrates directly into the abdominal cavity. The muscles are moved to the sides without any incisions. The last obstacle is the peritoneum. It is also cut between the clamps.

If there are no adhesions or adhesions in the peritoneum, the surgeon begins to remove the cecum with the appendix. Removal of the appendix is possible in two ways: retrograde and antegrade. The last option is used most often. In this case, the specialist ligates the vessels of the mesentery, applies a clamp to the base of the process, and then sutures it and cuts it off. Retrograde appendectomy is performed in a different sequence. First, the vermiform appendix is cut off, its stump is placed in the intestine, and sutures are applied. After this, the specialist gradually sutures the vessels of the mesentery, and it is removed. The need for such an operation is due to the localization of the appendix in the retroperitoneal space or the presence of numerous adhesions.

Transluminal appendectomy

This Access to the inflamed process is carried out through flexible instruments that the doctor inserts through natural openings on the body.

The intervention is possible in two ways: transvaginal or transgastric. In the first case, the instruments are inserted through a small incision into the vagina, and in the second - in the wall of the stomach. This operation has many advantages. It is characterized by a relatively short rehabilitation period, rapid recovery and the absence of visible cosmetic defects. Unfortunately, such a procedure is not performed in every clinic and only on a paid basis.

Laparoscopic appendectomy

This belongs to the category of gentle methods of therapy. It has the following advantages:

low morbidity;
absence of cosmetic defect;
fast recovery period;
possibility of using local anesthesia;
low likelihood of complications.

On the other hand, laparoscopic appendectomy has several disadvantages. For example, it requires expensive equipment, and the doctor must have the appropriate knowledge. In particularly serious clinical cases, especially with peritonitis, it is impractical and even dangerous.

What are the key points of a laparoscopic appendectomy? The course of the operation includes:

Performing a small puncture in the navel area. Through it, the doctor inserts a laparoscope and examines the cavity from the inside.
Several additional incisions are made in the pubic area and right hypochondrium. They are necessary for inserting surgical instruments. The doctor grabs the appendix, ties the blood vessels and cuts off the mesentery. After this, the process is removed from the body.
The specialist performs sanitation of the abdominal cavity and, if necessary, installs drainage.

Only in rare cases is laparoscopic appendectomy accompanied by complications. The progress of the procedure is controlled by several doctors at once, so the cosmetic effect is determined by their efforts and skills.

Recovery period

During rehabilitation, wound care is of particular importance. Dressings are carried out every other day, and if there are installed drainages - daily.

Many patients complain of discomfort and even pain several hours after the intervention. Such symptoms are considered natural and should not be alarmed. In case of urgent need, the doctor prescribes analgesics to the patient.

Most patients during the recovery period prefer to remain strict, citing weakness. This is wrong. The sooner the patient begins to move, the lower the risk of complications. Even a short walk around the ward or hospital allows the intestines to get back to work faster.

Contraindications

This operation has virtually no contraindications. However, to carry out the procedure safely, the doctor must assess the patient’s condition. For example, laparoscopic appendectomy is not recommended in the following cases:

More than 24 hours have passed since the first signs of the disease appeared.
The presence of concomitant inflammatory processes in the gastrointestinal tract.
Previously diagnosed serious diseases of the cardiac or pulmonary systems.

In these cases, the laparoscopic appendectomy technique is replaced by the traditional one.

Possible complications

Complications may occur after the intervention, so the patient requires constant monitoring. The operation itself proceeds safely, and negative consequences are most often caused by the unusual localization of the appendix in the abdominal cavity.

What complications can patients expect from appendectomy? The most common consequence of the operation is suppuration of the suture. Every fifth patient has to face this problem. The development of peritonitis, thromboembolism, and adhesive disease is also possible. The most dangerous complication is sepsis, when purulent inflammation becomes chronic.

Cost of the procedure and patient reviews

An appendectomy is an operation that is usually performed in emergency cases. A person can die. Therefore, it is illogical to talk about the cost of this type of therapy. A traditional appendectomy is free of charge. The patient's social status, age and citizenship do not matter. This order has been established in all modern states.

Doctors can save a person's life by performing surgery on him. However, follow-up and diagnosis often require additional costs. For example, a general blood or urine test costs about 500 rubles. For a consultation with a specialized specialist, you will have to pay a little more than 1 thousand rubles. Post-intervention costs associated with continued treatment are usually covered by insurance.

An appendectomy is an unplanned operation. Therefore, patients' opinions about the therapy they receive often vary. If the pathology was limited in nature, and medical care was provided in a high-quality and timely manner, the reviews will be positive. Laparoscopy leaves a particularly good impression. After all, literally a few days after the intervention, the patient can return to normal life. Complicated forms of the disease are much worse tolerated, and negative memories remain in patients forever.

Indications for surgical intervention.

The diagnosis of acute appendicitis of any form and stage is an absolute indication for appendectomy.

Contraindications there is no need to perform the operation other than the agonal state of the patient. Mainly, the surgeon decides on the choice of option for performing the intervention.

Technique for performing appendectomy surgery.

In the traditional version of appendectomy, a small (5-7 cm) incision is made in the abdominal wall in the right superior iliac region, and the vermiform appendix is brought out into the wound along with the cecum. The mesentery that feeds it and the base of the process are tied with an absorbable thread, the process is cut off, the stump is treated with an antiseptic, and a purse-string suture is placed on the cecum. By tightening it, the stump of the process plunges into the lumen of the cecum. An examination of the abdominal cavity limited to a small incision is performed, the latter is drained with tampons from the inflammatory effusion. If there is purulent effusion, the cavity is washed and drainage is left.
Laparoscopically, this intervention can be performed using two different techniques. First - according to Goetz, when, as with the open technique, an endoloop of absorbable suture material, usually catgut, is placed on the appendix, and the mesentery of the appendix is coagulated. Unlike the open technique, the appendix stump is often not buried in the cecum. The second technique is that both the mesentery and the process are sutured with an endosurgical stapler. The three-row suture of miniature titanium staples ensures complete sealing of the sutures, good hemostasis and does not cause further tissue reactions. The percentage of complications with the second option is 2-4 times lower than with the first, however, the cost of disposable cassettes increases costs by approximately 10 times ($250-300). See also ABCD - the ABC of laparoscopy: description of the technique, advantages, disadvantages.
Open surgery can be performed either under general anesthesia or (less commonly) under local anesthesia. Laparoscopic - under anesthesia.

Complications of appendectomy

Duration of hospitalization. With the traditional surgical technique, skin sutures are removed on days 5-8, and depending on the severity of the preoperative condition and postoperative course, the patient is discharged from the hospital 6-12 days after surgery. Working capacity is restored within a month. After laparoscopic surgery, the sutures, as a rule, are not removed; discharge is carried out 3-5 days after the intervention; work capacity is restored after 10-15 days.

Postoperative regimen and rehabilitation.

Advantages The laparoscopic option for performing appendectomy is somewhat controversial, and you can hear diametrically opposed opinions from different specialists. The complication rate for both options is low, the hospital stay is short, rehabilitation is quick, and the injury is minor. With laparoscopy, the cosmetic effect is slightly better (instead of a 5-7 cm incision - two or three 0.5-1 cm each, the umbilical incision is invisible), there is practically no postoperative pain. The main advantage of laparoscopy is the possibility of a detailed, thorough examination of the entire abdominal cavity, which cannot be done with the usual option. This allows you to reliably establish the cause of the symptoms and, if necessary, perform any other intervention instead of an appendectomy.