Appendicectomy

Question 1

Define appendicectomy.

Answer 1

Appendicectomy is the surgical removal of the vermiform appendix.

Question 2

What are the indications for an appendicectomy?

Answer 2

• Clinical signs of localised/diffuse peritonitis especially if leukocytosis is present
• History of persistent abdominal pain, fever.
• If unsure, short period (4-6hrs) of watchful waiting followed by CT scan to improve diagnostic accuracy

Some studies have shown that in acute uncomplicated appendicitis, antibiotic therapy is sometimes sufficient.

Question 3

What are the operative options for appendicectomy?

Answer 3

• Open - safest option for pregnant women
• Laparoscopic - better cosmetic outcome, shorter hospital stay, reduced postop pain, reduced wound infection so recommended for uncomplicated appendicitis.

Choice depends upon experience of the surgeon.

Question 4

What are the immediate, short term and long term complications of appendicectomy?

Answer 4

Immediate

• Bleeding
• Injury to bowel, bladder, ureter, liver, spleen
• Conversion to open surgery/laparotomy
• Removal of ovary/ fallopian tubes
• Stoma
• Anaesthetic risks - damage to teeth, throat, larynx, medication reactions

Early

• Pain, bleeding, infection
• Blood clots
• Stroke, MI, AKI, death

Late

• Hernia - avoid heavy lifting for 6 weeks
• Adhesions
• Reintervention

Question 5

What is a disadvantage of the laparoscopic approach to appendicectomy?

Answer 5

Intra-abdominal abscesses have previously been noted to be more common in adults who undergo laparoscopic appendectomy

Question 6

What is the link between appendicectomy and UC?

Answer 6

Appendicectomy - appears to be ‘protective’ against the development of UC, particularly if performed for appendicitis or for mesenteric lymphadenitis before the age of 20. It also influences the clinical course of UC, with a lower incidence of colectomy and reduced need for immunosuppressive therapy. By contrast, appendicectomy may increase the risk of development of CD.