Appendectomy: when removal of the appendix becomes essential

Appendectomy is now reserved for the most serious cases of appendicitis. Advances in medical imaging and diagnostic tools effectively make it possible to distinguish simple appendicitis, which can be treated with antibiotics, and the more complicated forms (peritonitis), which require surgery. We take stock.

Appendicitis means inflammation and/or acute infection of the appendix (a natural diverticulum located in the lower part of the large intestine). It is linked to the many bacteria that inhabit the intestine, and favored by an obstruction linked to the stool (stercolith).

The appendix begins to swell. It then becomes more and more sensitive and may end up forming an abscess filled with pus. When this abscess perforates and empties into the abdomen, it causes a peritonitisthe main indication for surgery.

The main symptoms of appendicitis are: abdominal pain (lower right of the belly), a slight fever, of the nausea, and sometimes vomitings. The abdomen ends up being tense and very painful, the fever rises and the fatigue worsens.

Its diagnosis is based on a clinical examination and a blood test. It must be confirmed by an ultrasound or CT scan.

What is an appendectomy?

Appendectomy is the standard treatment for appendicitis. As its name suggests, this intervention involves removing the appendix to avoid complications such as the formation of an abscess or its rupture (peritonitis). We are talking about removal of the appendix. Even if it may seem impressive, this intervention has no consequence: the cellular tissues compensate for its loss.

Acute attacks, peritonitis, appendicular abscess… Why do we practice it? What are its alternatives?

Appendectomy is indicated in the case of appendicitis, in adults, as in children. Indeed, appendicitis attacks can occur at any age, with two peaks in prevalence: between 10 and 14 years old, then between 25 and 35 years old. However, removal is not recommended in all cases:

  • In case of non-acute appendicitis (without notable complications), doctors generally recommend a course of antibiotics, until the symptoms disappear.
  • In case of localized peritonitis (when an abscess has formed in the appendix), doctors also recommend treatment with antibiotics. If necessary, they can perform a puncture of the abscess, under ultrasound or scanner. Appendectomy is only considered as a last resort.
  • In case of generalized peritonitis (when infectious fluid has spilled into the belly), appendectomy is performed urgently.

Note: non-steroidal anti-inflammatory drugs (NSAIDs) and opioid painkillers may also be prescribed during an appendicitis attack. In case of nausea and/or vomiting, antiemetic treatment may be considered.

Why are there no more appendicitis operations?

The removal of the appendix is ​​less and less widespread in France. Indeed, medical teams have long feared that non-acute or acute appendicitis may progress to peritonitis or abscess. In fact, surgeons tended to operate on the slightest suspicion. Today antibiotics are much more often acclaimed.

In the 1980s, there were nearly 300,000 appendectomies per year. A figure that fell to 83,400 in 2012, according to a report by the Department of Research, Studies, Evaluation and Statistics (Dress) published in February 2014. To date, between 60,000 and 70,000 operations are carried out each year in France.

The intervention consists of extract the diseased appendix and to clean the area of ​​infection to eliminate bacteria. Patients must arrive with an empty stomach the day of the operation (no food or drinks are allowed). They are also infused to stay hydrated and allow the injection of possible drugs through the vein (antispasmodics, analgesics, antibiotics).

In the majority of cases, it is carried out by laparoscopy : the surgeon introduces gas inside the patient’s abdominal cavity to better visualize his organs. He then introduces a microscopic camera and specific instruments through the navel. In some cases, however, the surgeon is forced to open the patient’s stomach during the operation, especially in the event of a complication or when the appendix is ​​located in an unusual place).

The intervention can also be performed by “classic” way to facilitate the procedure, due to the size of the appendix, its location, the degree of infection, the patient’s gender or build. The surgeon then makes a 2 to 3 cm incision on the right side of the abdomen and proceeds with the ablation.

Certain lesions (abscess, peritonitis, inflammation, etc.) may cause intestinal wounds. In this case, these lesions contraindicate removal of the appendix. He drainage may be essential for 5 to 7 days. The intervention can then be scheduled in the months to come.

Please note: the technique used has no effect on subsequent treatment. Moreover, once extracted, the appendix is transferred to the laboratory for anatomopathological analysis to confirm the diagnosis and eliminate another cause (Crohn’s disease, tumour, etc.).

What anesthesia for such an operation?

Whichever method is used, the intervention takes place under general anesthesia.

A additional anesthesia of the abdominal wall can also be performed under ultrasound to improve the patient’s postoperative comfort.

What is the risk of scarring?

Appendectomy systematically leaves a small scar, which gradually fades over time:

  • three small scarsif performed by laparoscopy
  • Where a very thin scar a few centimeters if necessary (bottom right of the navel).

Duration of hospitalization: how long does it take to recover from such an operation?

The postoperative course is often very simple. If there are no complications, the patient may be discharged:

  • the same evening, if he is treated on an outpatient basis
  • or in the following days, if he is hospitalized (especially in the case of appendicular peritonitis.

Patients can immediately resume their usual diet. Recovery can take between ten and twenty days, depending on the patients, their medical history and their lifestyle.

Complications: is the removal of the appendix dangerous?

The removal of the appendix does not necessarily lead to complications. Following the introduction of gas into the abdomen, however, patients may feel distension of the abdominal wall.

A hematoma can also form around the scar.

Some patients experience nausea, vomiting, or even a total cessation of intestinal transit.

Finally, following general anesthesia, they may be subject to significant fatigue.

Let’s not forget to mention the allergic, toxic and even fatal risks associated with general anesthesia and the drugs used during the procedure.

Convalescence: what monitoring after an appendectomy?

Each patient must observe a strict period of rest and supervision after their operation. Several measures must be respected:

  • watch the rest and follow your doctor’s recommendations;
  • follow the antibiotic treatment you have been prescribed to the letter (to avoid any risk of antibiotic resistance);
  • report any abnormalities to your attending physician or surgeon (vomiting, persistent fever, reappearance of pain, etc.);
  • respect the follow-up consultations prescribed after the appendectomy.

To note : a work stoppingmay be prescribed for one to four weeks, depending on the surgical technique used, the patient’s state of health, profession, and possible complications.

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