Acute appendicitis - One of the most common sharp (requiring emergency surgery) of surgical pathologies, which is characterized by inflammation of the appendix - a black-shaped intestinal process.

Acute appendicitis: figures and facts:

• In developed countries (Europe, North America), acute appendicitis occurs in 7 - 12 out of 100 people.
• From 10% to 30% of patients hospitalized in surgical hospital for emergency testimony are patients who suffer from acute appendicitis (ranked second after acute cholecystitis - Inflammation of the gallbladder).
• From 60% to 80% of emergency operations are performed due to acute appendicitis.
• In Asia and Africa, the disease occurs very rarely.
• 3/4 Patients with acute appendicitis are young people under the age of 33.
• Most often, the inflammation of a worm-like process occurs aged 15-19 years.
• With age, the risk of getting sharp appendicitis is reduced. After 50 years, the disease occurs only 2 people out of 100.

Features of the structure of a worm-like process

Iliac i. colon It is connected not to the "end to the end": the small intestine seems to be in thick on the side. Thus, it turns out that the end of the colon is blindly closed in the form of the dome. This segment is called a blind intestine. From him and departs a worm-shaped process.


The main features of the anatomy of Appendix:

• The diameter of the black-shaped process in an adult is from 6 to 8 mm.
• Length can be from 1 to 30 cm. On average - 5 - 10 cm.
• A worm-shaped process is located in relation to the blind intestine of Knutrice and a little kice. But there may be other options for location (see below).
• Under the mucous membrane of a worm-like process, a large cluster of lymphoid fabric is located. Its function is to neutralize pathogenic microorganisms. Therefore, Appendix is \u200b\u200boften called the "abdominal almond".
• Outside Appendix is \u200b\u200bcovered with a thin film - peritoneum. He's hanging on it. It takes vessels that feed a heart-shaped process.

How can appendix be located?

Options for improper arrangement of a draft-shaped process:

Picture	Explanation
	Near the sacrum.
	In a small pelvis, next to the rectum, bladder, uterus.
	Rear from the rectum.
	Next to the liver and bubble.
	From the front of the stomach - this arrangement of a worm-shaped process happens under malrotation - defective development, when the intestine is underdeveloped and does not occupy a normal position.
	On the left - during the reverse position of the organs (while the heart is on the right, all organs, as it were, in the mirror reflection), or with excessive mobility of the blind intestine.

Causes of appendicitis

The main symptoms of acute appendicitis:

When, when acute appendicitis, you need to call "ambulance"?

Before the arrival, the doctor cannot take any medicine. After their reception, the pain subsides, the symptoms of appendicitis will be expressed not so much. This can enter a misconception: examined the patient, it will come to the conclusion that there is no acute surgical disease. But the well-being caused by the effects of drugs is temporary: after they stop acting, the condition is even more worse.

Some people when they begin to bother constant abdominal pain, refer to the clinic to the therapist. If a suspicion arises in the fact that the patient "acute belly", he is sent to the counseling for the surgeon. If he confirms the concerns of the therapist, then the patient will be taken to ambulance in a surgical hospital.

How does the surgeon inspect the patient with a sharp appendicitis?

What can a doctor ask?

• Where is the stomach hurts (the doctor asks the patient himself)?
• When did the pain appear? What did the patient do, ate before it?
• Was there a nausea or vomiting?
• Was the temperature rises? What figures? When?
• When was the last time a chair? Was he liquid? Did he have an unusual color or smell?
• When was the patient for the last time ate? Does it want to eat now?
• What other complaints are?
• Did the patient removed in the past appendix? This question seems banal, but he is important. Appendicitis cannot occur twice: during surgery, the inflamed worm-shaped process is always removed. But not all people know about it.

How does the doctor inspect the stomach, and what symptoms checks?

With acute appendicitis, many specific symptoms are detected. The main ones are:

Is it possible to immediately make a diagnosis?

Sometimes it happens that the patient is delivered to the surgical hospital, he inspects the doctor, but even after a thorough inspection there are doubts. In such situations, the patient usually leave in the hospital for a day and is observed for its condition. If the symptoms are enhanced, and there is no doubt about the presence of acute appendicitis, carry out operation.

Observation of the patient with suspicion of acute appendicity to carry out at home. He must be in the hospital, where it will be regularly examined by the doctor, and when the state deteriorates, it will immediately be sent to the operating room.

Sometimes it happens that there are bright signs of acute appendicitis, and making a cut, the surgeon detects a healthy appendix. This happens very rarely. In such a situation, the doctor must carefully examine the intestine and the abdomen cavity - the other surgical disease has been disguised as an acute appendicitis.

• Gynecological pathology : Inflammation and Jews uterine pipes and ovaries, ectopic pregnancy, twist the legs of the tumor or cysts, the apochy of the ovary.
• Renal colic on the right .
• Acute inflammation of the pancreas .
• Acute gallbladder inflammation, bile colic .
• The ulcer of the stomach or duodenal intestine, which passes through the wall of the organ .
• Intestinal colic - A condition that often imitates acute appendicitis in children.

Analyzes and research in acute appendicitis

Laparoscopy in appendicitis

What is laparoscopy?

What are the indications for laparoscopy with acute appendicitis?

• If the doctor is watching the patient for a long time, but still can not understand: he has acute appendicitis, or not.
• If the symptoms of acute appendicitis arise from a woman and strongly resemble gynecological disease. As statistics show, in women every 5th - 10th operation in suspected appendicitis is mistakenly performed. Therefore, if the doctor doubts, it is much more expedient to resort to laparoscopy.
• If symptoms are available in a patient with diabetes mellitus. For such patients, it is impossible to observe long - they have blood circulation, immune protection has been reduced, therefore complications are developing very quickly.
• If acute appendicitis is diagnosed in a patient with an excess body and well-developed subcutaneous fat. In this case, when the laparoscopy fails, it would have to make a big incision, which long heals, can be complicated by infection and suppuration.
• If the diagnosis is not in doubt, and the patient itself is asking for a laparoscopically operation. The surgeon may agree in the absence of contraindications.

What will the doctor sees during laparoscopy?

How is laparoscopy under acute appendicitis?

Is it possible during diagnostic laparoscopy to immediately operate acute appendicitis?

Treatment of acute appendicitis

Surgical treatment of acute appendicitis

Operation in acute appendicitis is called appendectomia. During her, the doctor removes a heart-shaped process - in a different way to get rid of the focus of inflammation.

Types of operation in acute appendicitis:

• Open intervention. It is most often done, as it is easier and faster, it does not need special equipment for it.
• Laparoscopic appendectomy. Performed according to special readings (see above). It can be carried out only if there are endoscopic equipment and trained specialists in the clinic.

Medical treatment with acute appendicitis

Before and after surgery, antibiotics prescribe:

In the second half of pregnancy, a woman is difficult to try to try his belly. The enlarged uterus shifts the black-shaped process up, so the pain occurs above its normal location, sometimes directly under the right edge.

A reliable and secure method of diagnosing appendicitis in a pregnant woman is an ultrasound study.
The only method of treatment is an operation. Otherwise, both mother and fruit can die. During pregnancy, laparoscopic intervention is often performed.

Acute child appendicitis

Features of acute appendicitis in children under 3 years old:

• It is impossible to understand whether the child has a belly, and if it hurts, in the same place. Little children cannot explain it.
• Even if the child can point into place of pain, it usually shows the area around the navel. This is due to the fact that Appendix at an early age is not quite as in adults.
• The child becomes sluggish, capricious, often crying, sucks with legs.
• Dream is disturbed. Usually the child becomes restless in the late afternoon, not sleeping and cries all night. It makes parents for the morning to call " Ambulance».
• Vomiting arises 3 - 6 times per day.
• The body temperature is often rising to 38 - 39⁰.

Prevention of acute appendicitis

• Proper nutrition. In the diet, a sufficient amount of dietary fibers (vegetables and fruits), dairy products should be present.
• Timely treatment of any infections and inflammatory diseases.
• Fighting constipation.

A worm-shaped process departs from the blind intestine at the venue of three trimming, 2-3 cm below the level of the imposition of the ileum in the blind. The average length of its 8-10 cm, however, there are cases of finding very short and very long (up to 50 cm) processes. The localization of the base of the heart-shaped process is almost constant, and is projected onto the front abdominal wall at the McBurney point - on the boundary of the outer and medium third-line line, spent from the navel to the front of the upper ileum. The free end (top) of the process may be in different positions (Fig. 1). The retrocecal arrangement of the process is observed in 10-15% of cases, while in very rare cases the process lies not only behind the blind intestine, but also extra-stock (retroperitoneal position of the process). The variability of the location of the blind intestine and the appendix itself is one of the factors that cause various localization of pain and variety of options for a clinical picture in the development of inflammation of a worm-like process, as well as the difficulties of its detection during surgery.

Fig. 1. Various localization of the top of the draft-shaped process

The Cell-shaped process has its own triangular shape mesenter, heading toward the blind intestine and the final iliac finite. The mesentery contains fatty tissue, vessels, nerves and several small lymphatic vessels. At the base of the heart-shaped outflow, there are folds and pockets of peritonevos, which contribute to in some cases the gradation of the inflammatory process. Breakfasts a black-shaped process from a. IleoColica through a. Appendicularis, which takes place in the thickness of the mesentery of the process and can be represented by one or more branches. The venous outflow is carried out according to the veins of the same name in the upper mesenteric and further in the portal vein. In addition, there are close collateral connections with the lower hollow vein, as well as with the veins of the kidneys, the right ureter, the retroperitoneal space. Lymphatic vessels begin in the form of capillaries in the mucous membrane of a worm-like process. At the base of the crypt, the first capillary network is formed, which connects with a more powerful submissible network. The latter excommates lymphatic follicles. Then the lymphatic vessels, merging and penetrating through the muscular shell, drainaged into the lymph nodes of the mesentery, located in the region of the ileocecal angle and further - in the total current of lymphs from the intestine. The main lymph nodes of the draft-like process are two groups: appendicular and ileocecal. It should be noted that there are close connections lymphatic systems Drawberry process and other organs: blind intestine, right kidney, duodenal gut, stomach. The existence of such branched vascular bonds makes it clear the possibility of various ways to spread infection in acute appendicitis and the development of purulent complications, such as the romboosis of the veins, thrombophlebitis golden Vienna (Pylephlebit), phlegmon Picrintshawic fiber, liver and kidney abscesses.

The innervation of a worm-like process is carried out at the expense of the branches of the upper mesenteric plexus and, partly, due to the nerves of solar plexus. This explains the widespread and diverse localization of pain at the beginning of the disease.

The wall of the black-shaped process is represented by serous, muscle and mucous membranes. The muscular shell has two layers: outdoor - longitudinal, and internal - circular. It is important in the functionality of the submembraty layer. It is permeated with crucifically crossed collagen and elastic fibers. There are multiple lymphatic follicles between them. In adults, the number of follicles per 1 cm 2 reaches 70-80, and their total amount reaches 1200-1500 with a diameter of the follicle 0.5 - 1.5 mm. The mucous membrane forms folds and crypts. In the depth of the crypt, the cells of the paniet are located, as well as the cells of the Kulchik producing serotonin. Epithelium mucosa Single-row prismatic with a large number of glass-shaped cells producing mucus.

Famous physiological functions of a worm-like process:

motor function is provided by a muscular layer. With its insufficiency in the lumen of the process, there is stagnation of contents, honeystones are formed, delayed foreign bodies, Helminty.

the secretory function provides the products of mucus and some enzymes.

immunoglobulin products.

The removal of appendicitis is a common operation conducted in the abdomen. Another name of surgical manipulations - appendectomy.

Now the pathology is treated in two ways:

• Conducting conservative therapy. Treatment passes using drugs.
• Full surgical clipping of the inflamed area.

Often after medicines have to remove the process.

Surgery is carried out by two basic methods:

• A longitudinal incision is performed on the side of the abdomen, in the area of \u200b\u200bappendix.
• Make three punctures where the organ is located.

There is another method with one puncture and removal through your mouth or vagina. Gradually, these methods refused to favor the above.

• Pregnant.
• Children under 6 years old.

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

In women in the position, constant constipation, changing and squeezing the organs of the growing uterus lead to the overlapping of the Passage of Apandix and the emergence of inflammation. Reducing immunity due to changes in the hormonal background.

The main reason showing the need for an operation is an acute form of inflammation of the appendix or. Other factors leading the patient to the operating table:

• Strengthening symptoms of body poisoning with inflammatory process.
• Violation of the integrity of the process and entering the internal organs of purulent products, the development of peritonitis.
• Increased risk of rupture.

Depending on the state of the patient and the stage of the disease, the operation is carried out in two options:

1. According to plan.
2. Especially, or urgent form.

Planned

Operational intervention is used if it is impossible or banned for removal. This is usually carried out in the presence of infiltrate. Originally executed medicia treatment To remove the sharp shape, and then it is assigned to clipping when there is no threat to the health and life of the patient.

Urgent

Acute form of the disease provokes emergency removal. It happens when the organ and peritonite breaks.

The development of chronic appendicitis is associated with a periodic emergence of a uncomfortable state. Its treatment passes using medicines and surgical method. Methods choose a doctor. If the symptoms appear infrequently and non-intensive, try to treat with medicines.

Diagnostic examination

Before you perform the removal of the body, the examination is carried out and analyzes. This is done to eliminate other pathologies to confirm the diagnosis.

Inspection

The surgeon pre-examines the patient to identify the symptoms of appendicitis. The procedure consists in palpation and closing the body of the body, where it hurts, the preliminary location of the outflow. Attention is drawn to what the pose is occupied by the patient. A visual inspection of the abdomen is performed. At the site of inflammation, skin covers will be raised and inflamed.

For blood tests and urine tests to determine the degree of inflammation and eliminate diseases with similar symptoms.

Instrumental examination

The use of equipment is necessary for the formulation of an accurate diagnosis and location of the outflow:

• Ultrasound procedure.
• Computed tomography using contrast.

Types of operational intervention

Appendectomy is the removal of the inflamed organ (appendix) surgical way. The entire process is cut out, the residues are sutured and hiding inside the blind intestine.

In surgical practice, two main ways of interference inside the patient's body are used:

1. Laparotomy. The incision is made in the area of \u200b\u200bfinding the inflamed appendix. Open operation.
2. Laparoscopy (endoscopy). For removal, small punctures (three) in the abdomen area are produced.

Methods have both positive moments and negative.

Lapotomy

It is a classic way. Laparotomy is the first extension operation at Appendix. Indications:

• The diagnosis was confirmed - appendicitis in acute form.
• The sharp shape gave complications - peritonitis.
• The consequences of acute illness in the form of infiltrate that connected the appendix, the blind intestine, the delicious intestine and the gland.
• Chronic type appendicitis.

Peritonitis and clinic in the acute form of the disease are indicators for the operation urgently. When inside is infiltrate, apply conservative treatmentaimed at removing the inflammatory process. Therapy may occupy 2-3 months. Then a scheduled deletion is assigned.

When it is impossible to carry out laparotomy:

• In a patient agony.
• If the patient independently, in writing it refuses surgical manipulations.
• Planned intervention. Dysfunction of cardiovascular system, breathing, kidneys and liver.

Preparation for the operation does not require special events. If the patient has a violation of the water-salt balance or the peritonitis developed inside, then intravenous administration The organism includes fluids and antibiotics of a wide range of action.

Procedure surgery:

1. The introduction of anesthetic solution. Anesthesia is made common. The solution enters the body or through an injection into a vein or through the inhalation apparatus. Extremely rarely administration of anesthesia passes through the cerebrospinal channel.
2. The place of the future operation is treated antiseptic means. As disinfecting substances use iodine on alcohol, betadine, alcohol.
3. The incision is done in the field of finding appendicitis. Penetration inside is carried out by a layer-by-layer cutting of tissues.
4. An visual inspection of internal content is performed. Appendix rises above the authorities.
5. The process is cut off (carry out resection). At the same time, the seams are superimposed into the place of the flushing of the mesentery and appendix.
6. Then the extra liquids are removed, the drainage system is set (tube for taping inflammation products), carry out the tampon and electric lines.
7. The cut on the peritoneum is sewn with special threads. Closes access by layer-by-layer tissue crossing in reverse order from penetration.

Accessses inside the peritoneum are carried out in the following options:

• Method of Volkovich-Dyakonov, an incision for oblique.
• Method of Lenander. Incision on the longitudinal.
• Access using cross-cut.

Drainage is performed in several cases:

• Apandix gap and the development of peritonitis.
• Mouth education at the venue.
• Inflammation develops in the retroperitoneal fiber.
• Incomplete blockage of blood vessels damaged as a result of operational intervention. Incomplete hemostasis arteries.
• There are no definite testimony to cut the inflamed organ.
• There was an incomplete immersion of the remnants of the process into the body of a blind intestine.

Clean drainage after 2-3 days, if healing passes without complications.

The cutting process at laparotomy goes from 40 minutes to one hour. If complications are present (adhesive disease, improper arrangement of the organ), then the surgical process lasts from two to three hours. The recovery process has duration up to a week. Compliance with the beddown is recommended within 2-3 days from the day of the operation. Exterior seams are removed by 7 or 10 days.

Laparoscopy

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

When the use of a minimally invasive removal of the process is shown:

• The first day of the development of the acute form of the disease or light form illness.
• Deals from chronic form.
• The child develops acute appendicitis.
• Related diseases of the patient provoking poor wound healing and subsequent suppuration. These include diabetes and overweight.
• Written statement of the patient about the use of laparoscopic appendectomy.

Consider cases where the use of the method is prohibited or undesirable.

Contraindications of general nature:

• Recent months of pregnancy.
• Cardiovascular diseases of acute type. Insufficiency or infarction state.
• Light dysfunction, provoking respiratory failure.
• Blood blood intake.
• Conducting general anesthesia is undesirable.

Contraindications of local importance:

• Appendicitis develops longer than a day.
• The development of peritonitis.
• Plots of purulent processes with china or blurred edges.
• Fast disease in the peritoneum.
• Access to appendix is \u200b\u200bdifficult because of the wrong location.
• Around the organ thin gut And the thick intestines are inflamed tissue with a changed structure - infiltrate.

Removal operation is carried out without special training. Under appendicitis, the process takes at least time: a dropper containing saline is installed, antibiotic products are introduced wide spectrum actions. In the operating patient, the tube with anesthetic solution is inserted, which is introduced in the inhalation method. Laparoscopy is carried out only under general anesthesia.

The removal of appendicitis is carried out without a cut, using special medical instruments:

• Laparoscope.
• Tube for injection of carbon dioxide, which is called an insuffler.
• Laser to cut off the process.
• Monitor, which makes it possible to observe the passage of the operation and inspection of the internal situation.

Laparoscopy passes in several stages:

• The place of future interventions is prepared. Holes in the abdomen area for the introduction of medstruments are performed.
• Inspection of the abdominal cavity from the inside. Carbon dioxide is launched into the abdominal cavity, which allows the revision better quality.
• After finding Appendix fixes for the center or end. Then the clip is: first the mesentery, and then the organ itself. After the carved organ, the process remains and connective tissue. The seams are superimposed into the seams: separately on the mesentery, separately on appendix. The body is outwarded with a trocar. The procedure is performed carefully and professionally.
• Movement is removed and other liquids that appeared during the cutting process. If necessary, the drainage is installed.
• On the holes where the tools were, the seams are superimposed.

If at the inspection stage, complications included in the contraindications to laparoscopy were revealed, the tools are removed, a classic cut is carried out.

Sometimes after the operation, you may need to install drainage hoses:

• Signs of developing peritonitis were found.
• Blood vessels continue to bleed.
• The surgeon has no complete confidence: deleted completely organ or passed incomplete resection.

The tube is displayed through the puncture of the side.

The duration of operational intervention is 30 - 40 minutes. Complications can increase the time of up to 3 hours.

When was operated on, the recovery process takes 3 days. The drainage system is removed on the second day. Physical exercise Allowed after 60 days.

Endoscopic intervention in comparison with laparotomy has several advantages:

• Recovery takes place in a short time.
• On skin Covers Low most careful scars remain.
• After deletion pain syndrome Practically absent.
• Minimal injury to the front of the peritoneum.
• During laparoscopy, there is a possibility of attentive inspection of the internal content of the abdominal cavity and detecting additional pathological processes.
• The intestinal motor activity is rapidly restored.
• Mandatory bed regime is absent.
• After appendicitis, there is practically no complications.

However, the holding of a minimally invasive method is associated with some difficulties:

• It is necessary expensive equipment.
• Medical staff need to traine.
• General anesthesia.
• The surgeon is losing the ability of the tactile sensation.
• The data on the monitor is displayed in a flat form (two-dimensional space).

Stages of Appendectomy "\u003e

Stages of appendectomy.

Appendectomy - removal of a worm-like process (appendix).

Indications for surgery. Indication to the operation is acute appendicitis, as well as a state after transferred appendicular infiltrate . In acute appendicitis, the operation is performed in an emergency (no later than an hour from the moment of diagnosis); After transferred appendicular infiltrate, operate in a planned manner (from 2 to 6 months after acute stage Diseases).

Contraindications. With acute appendicitis of contraindications to appendectomy, there is no, with the exception of the agonal state of the patient. In the planned performance of the operation, there are heavy heart, lungs, liver, kidneys with contraindications.

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

Performing an operation. In the classic version of appendectomy produced through a small incision in the right bottom of the abdomen (iliac region). In the wound, the dome of the blind intestine with a heart-shaped process is displayed. The latter is tied up at the base and intersects, the mesentery is also carefully replicated by a separate thread and intersects. If at the time of the operation in the abdominal cavity in small quantity There is peritonial exudate (fluid arising from inflammation of the abdominal organs), it is removed by gauze tampon. When the peritonial exudate is distributed to most of the abdominal cavity - the presence of common peritonitis, - appendectomy is made from the median laparotomy . Recently, the extension of appendectomy is possible with laparoscopic equipment. At the same time, Appendix is \u200b\u200bremoved using special tools and equipment through separate point punctures. abdominal wall.

Possible complications. The emergence of complications in the course of the operation is rare. In the classical operating method, technical difficulties associated with an atypical arrangement of the abdominal process can occur. With laparoscopic appendectomy, the arrangement of the process does not affect the technique of the operation. IN postoperative period The most frequent complication is the suppuration of the abdominal wall operating wound (with purulent appendicitis with the presence of peritonitis, the frequency of wound suppuration can reach 20%). If the operation is performed by the laparoscopic method, the likelihood of wound suppuration is significantly reduced. A more rare postoperative complication is the formation of inflammatory infiltrates and abscesses (jets) in the abdominal cavity; The frequency of these complications in classical and laparoscopic methods is the same.

Extract from the hospital. If appendectomy is performed through an incision in the ileum region and does not occur complications, patients are discharged from the hospital for 5-7 days after the operation.

Postoperative period. Fully performance is restored in a month. With a laparoscopic execution of operation, patients can be discharged after 2-3 days, and performance is restored after 10-14 days.

Appendicitis treatment always implies operations. Before surgical intervention, the patient is prescribed preparatory activities: they take analyzes, they make x-rays and ultrasound, studies anamnesis. Only after receiving the survey results, the appendectomy proceeds. There are several varieties of this operation. We will talk about them in more detail in today's article.

What is appendicitis?

This is a sharp surgical disease, manifested by pain in the abdomen and symptoms of intoxication. It is characterized by inflammation of a worm-like process - Appendix. IN childhood He takes an active part in the local immunite. However, over time, this feature is lost. Cell-shaped process becomes useless education. Therefore, his removal does not carry 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. With the seeming simplicity of the diagnosis, it is quite difficult to reveal it at the initial stage. Pathology often "masked" for other diseases, has an atypical current. Regardless of which reason, appendicitis, appendectomy occurs is the only option of its treatment.

Indications for the operation

Appentectomy refers to the category of interventions that are carried out in an emergency order. At the same time, the main indication for the operation is an inflammatory process in acute form. Planned surgical intervention is prescribed in the case of this pathology, in which a worm-shaped process is merged with portions of the intestine, the gland or peritoneum. After her subsoia (about 2-3 months from the beginning of the disease) operation is carried out. If the symptoms of intoxication increase the spontaneously, the abscess occurs with the subsequent peritonitis, the patient needs emergency intervention.

Preparation for the procedure

Appendectomy operation lasts no more than an hour. During intervention, the general or selection of a specific variant depends on the age of the patient, its condition and the presence of related pathologies. For example, children and overweight people, as well as mental diseases or nervous exception recommended general anesthesia. Patients with thin physique are preferable to local anesthesia. To the same category include pregnant women, since total anesthesia negatively affects the fruit.

Appendectomy is an emergency operation. It does not imply enough time to prepare the patient. Therefore, the minimum number of surveys is appointed before intervention: blood and urine tests, ultrasound, x-ray. To eliminate pathologies of appendages, women additionally recommended consultation at the gynecologist.

Immediately before the operation itself bladder A catheter is installed, stomach washing. With constipation, the enema is shown. The entire preparatory stage lasts no more than 2 hours. After confirming the diagnosis, the doctor also defines a specific intervention option. Today, this operation is possible in several ways (traditional, laparoscopic and transversum).

Each of them will be described in detail just below.

Traditional appendectomy

The treatment of appendicitis in this way is customary to divide into two parts. At first, the doctor receives operational access, and then proceeds to the procedure for removing the blind intestine. Intervention lasts no more than one hour.

To access the inflamed process, the surgeon makes a cut on the skin in the right length, it is usually 7 cm. The reference point is the Mac-Burnea point. After the dissection of the skin and fatty fiber, the doctor penetrates directly into the abdomen. Muscles are moved to the side without cuts. The last obstacle is the peritoneum. It also dissect between the clamps.

If there are no spikes and fragments in the peritoneum, the surgeon embarks the blind intestine with a worm-like process. Removing appendix is \u200b\u200bpossible in two ways: retrograde and antimony. The last option is used most often. At the same time, the specialist bandages the vessels of the mesentery, imposes a clamp on the base of the process, and after it sides and cuts off. Retrograde appendectomy is carried out in a different sequence. First, a black-shaped process is cut off, its cult is placed in the intestine, the seams are superimposed. After that, the specialist gradually sides the mesense vessels, it is removed. The need for such an operation is due to the localization of appendix in the retroperitoneal space or the presence of numerous adhesions.

Transluder Appendectomy

This access to the inflamed process is carried out through flexible tools that the doctor enters through the natural holes on the body.

Intervention is possible in two ways: transvaginally or transgastrally. In the first case, the tools are introduced through a small incision into the vagina, and in the second - in the wall of the stomach. Such an operation has many advantages. It is characterized by a relatively small rehabilitation period, the rapid recovery and lack of visible cosmetic defects. Unfortunately, this procedure is not performed in each clinic and exclusively on a paid basis.

Laparoscopic appendectomy

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

• low trauma;
• lack of a cosmetic defect;
• fast recovery period;
• the possibility of using local anesthesia;
• the low probability of the development of complications.

On the other hand, laparoscopic appendectomy has several drawbacks. For example, it requires expensive equipment for its holding, and the doctor must have relevant knowledge. In particularly serious clinical cases, especially during the peritonitis, it is inexpedient and even dangerous.

From what key moments Is laparoscopic appendectomy? The operation of the operation includes:

1. Performing a small puncture in the navel area. Through it, the doctor introduces a laparoscope and examines the cavity from the inside.
2. In the pubic zone and right hypochondrium additionally make several cuts. They are needed to introduce surgical instruments. The doctor captures Appendix, bandages blood vessels and cuts off the mesentery. After this, the process is removed from the body.
3. The specialist conducts the abdominal cavity, if necessary, sets drainage.

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

Recovery period

During the rehabilitation, care for the wound is played. Dressing is carried out in a day, and in the presence of installed drainage - daily.

Many patients complain about discomfort and even pain a few hours after the intervention. Such symptoms are considered natural, they should not be frightened. In case of acute necessity, the doctor prescribes an analgesic patient.

Most patients during the recovery period prefers to observe strictly referring to weakness. It is not right. The earlier the patient will begin to move, the less the risk of developing complications. Even a short walk through the ward or hospital allows the intestines to turn into work faster.

Contraindications

This operation has practically no contraindications. However, for the safe conduct of the procedure, the doctor must estimate the patient's condition. For example, laparoscopic appendectomy is not recommended in the following cases:

1. It took more than 24 hours from the moment the first signs of illness appeared.
2. The presence of accompanying inflammatory processes In the gastrointestinal bodies.
3. Previously diagnosed serious diseases of cardiac or pulmonary systems.

In the cases listed cases, the laparoscopic technique of appendectomy is replaced by traditional.

Possible complications

The emergence of complications after intervention is possible, therefore, the patient requires constant monitoring. The Operation itself proceeds safely, and negative consequences are most often due to the unusual localization of the abdominal process.

What complications of appendectomy can expect patients? The most common consequence of the operation is the suppuration of the seam. With such a problem, it is necessary to deal with each fifth patient. The development of peritonitis, thromboembolism, adhesive disease is not excluded. The most dangerous complication is sepsis when purulent inflammation becomes chronic.

Cost of procedures and patient reviews

Appendectomy is an operation that is usually carried out in emergency cases. With a person can die. Therefore, it is illogical about the value of this kind of therapy. Traditional appendectomy is free. Social status of the patient, his age and citizenship do not matter. Such an order is instituted in all modern states.

Doctors can save the life of a person by making it an operation. However, subsequent observation and diagnostics often require additional expenses. For instance, general analysis Blood or urine costs about 500 rubles. For consultation, a profile specialist will have to give a little more than 1 thousand rubles. Costs after interventions related to the need to continue treatment are usually covered by insurance.

Appenctomy is an unplanned operation. Therefore, the opinions of patients about passed therapy are often varying. If pathology was limited, and medical care was provided with qualitatively and timely, the reviews will be positive. Especially good impressions leave after itself laparoscopy. After all, literally a few days after the intervention, the patient can return to her usual life. Complicated forms of the disease are extended significantly worse, and negative memories in patients remain forever.