Appendicitis (Laparascopic Appendectomy)What is appendicitis?Appendicitis is one of the most common complaints for abdominal pain in children. It is common in children from ages 4 to 15 years old; but can be seen in any age group. Appendicitis is an inflammation of the appendix. It is thought that appendicitis is due to various factors. One thought is that it may be due to blockage of stool which will form a stone (called a fecalith). Appendicitis can also result from enlarged lymph nodes caused by a viral infection. Once this blockage occurs, bacteria located within the appendix grow. The pressure in the appendix increases and the appendix becomes swollen. Eventually the blood vessels to the appendix close and the appendix dies; when this occurs "perforation" occurs which means the appendix ruptures.
Appenidicitis should be treated according to the symptoms, examination, and if required an ultrasound or CT. If the diagnosis is made for appendicitis an operation is required. Patients who present with a ruptured appendicitis will be treated with antibiotics followed by an appendectomy approximately 6 weeks later. How is appendicitis surgically repaired?The appendicitis can be repaired via laparoscope through three or two small incisions or "ports", or in can be performed through an open procedure using an incision. A benefit of the laparoscopic appendectomy is that the scar is smaller, and the surgeon has the ability to completely see the other structures inside the abdomen. With a three port operation, ports are placed through the belly button, the left lower abdomen and the right mid-abdomen. A space is created between the appendix and the blood vessels going to the appendix (the mesentery) near where the appendix joins the large intestine. A stapler which divides and seals is first fired across the blood vessels and then across the appendix itself. The appendix is then removed. With the two port technique a port is placed through the belly button and through the right lower abdomen. The appendix is grasped and brought up through the port site as the port is removed. An appendectomy is then performed outside of the body as the blood vessels and the appendix are tied off with sutures. The appendix is then removed. This technique is best used when an early appendicitis is present or a normal appendix is found. In some cases, an open appendectomy (instead of with a laparoscope) is performed through a longer right lower abdomen incision. Antibiotics are continued after the operation only in patients with ruptured appendicitis. Patients can usually start eating following the operation and, in most cases of non-ruptured appendicitis, are discharged in the first 24 hours. If the appendix has ruptured, antibiotics should be given to treat infection. Pain medication is administered. In many cases of ruptured appendicitis, the approach of interval appendectomy is applied: patients are first treated with antibiotics to allow the infection to go away. Abscesses (pus pockets) are drained out using the CT to guide placement of a needle into the abscess (Figure 7) Antibiotics are continued until the infection is gone. A peripherally-inserted central catheter (PICC) may be placed into a vein and the patient sent home on intravenous (IV) antibiotics once the child is eating a diet and pain is controlled on medication taken by mouth. Nutrition given into the IV may be necessary until adequate nutrition can be taken by mouth. Appendectomy is then performed after 6 to 8 weeks. The complications appear to be less with this approach of waiting before doing the appendectomy when the appendix has ruptured. For more information, visit the American Pediatric Surgical Association website. Are there activity restrictions after surgery?After surgery the child should not participate in vigorous physical activity or heavy lifting for 1-2 weeks. Are there bathing restrictions after surgery?Incisions should be kept clean and dry for 48 hours after surgery. After that time the child may shower or sponge bathe and pat the incisions dry. One week after surgery or when the incisions appear well healed the child may bathe or swim. When to call the doctor
Phone numbers and hoursWe are open Monday through Friday From 8:00am to 5:00pm. Office number is (734) 764-4151. After office hours and on weekends or holidays, call Paging at (734) 936-6267, and ask to have the Pediatric Surgery Resident on-call paged. |
The appendix is a finger-like projection that can extend down, toward the middle, upwards toward the liver, or behind the first portion of the large intestine which is called the cecum.
