Acute surgical pathology acute appendicitis. Acute appendicitis

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Acute appendicitis - inflammation of the appendix of the caecum, fraught with the development of purulent peritonitis and abdominal abscesses.

ICD-10 CODE
K35. Acute appendicitis.

Epidemiology

Acute appendicitis is the most common surgical pathology, occurring in 4-5 people per 1000 population. The most common disease occurs between the ages of 20 and 40, women get sick 2 times more often than men.

Prevention

Since the causes of the disease are unclear, there is no evidence for preventive measures. In the 20-30s. 20th century often performed prophylactic appendectomy. This method is currently not used.

Classification

Appendicitis:

catarrhal;
phlegmonous;
gangrenous.

Complications:

appendicular infiltrate;
perforation;
purulent peritonitis;
abscesses of the abdominal cavity (periappendicular, pelvic, interintestinal, subdiaphragmatic);
retroperitoneal phlegmon;
pylephlebitis.

Forms of acute appendicitis essentially reflect the degree of inflammatory changes in the appendix, that is, the stage of the inflammatory process. Each of them has not only morphological differences, but is also characterized by its inherent clinical manifestations. In this regard, the final diagnosis should contain information about the appropriate form of the disease.

Due to the peculiarities clinical course specifically describe the empyema of the appendix, which morphological features very close to phlegmonous appendicitis.

All complications are directly related to inflammatory changes in the appendix, however, most of them (except for perforation, appendicular infiltrate and periappendicular abscess) can also be postoperative complications.

Etiology and pathogenesis

The causes of acute appendicitis have not yet been fully established. A certain role is played by the alimentary factor. Putrefactive processes in the intestine, dysbiosis contribute to the disruption of the evacuation function of the appendix, which should be considered a predisposing factor in the development of acute appendicitis. AT childhood some role in the occurrence of acute appendicitis is played by helminthic invasion.

The main route of infection of the appendix wall is enterogenic. Hematogenous and lymphogenous variants of infection are quite rare and do not play a decisive role in the pathogenesis of the disease. The direct causative agents of inflammation are a variety of microorganisms (bacteria, viruses, protozoa) that are in the process.

Pathological characteristics

The initial phase of inflammation of the appendix is referred to as acute. catarrhal appendicitis(simple or superficial appendicitis). Macroscopically, the process looks thickened, its serous membrane is dull, under it one can see many small vessels filled with blood, which gives the impression of bright hyperemia (Fig. 43-1).

Rice. 43-1. Acute catarrhal appendicitis (photo during surgery).

On the section, the mucous membrane of the process is edematous, gray-red in color, spots of hemorrhages are sometimes visible in the submucosal layer.

The lumen of the appendix often contains a blood-like liquid. Microscopically, it is possible to note small defects in the mucous membrane, covered with fibrin and leukocytes. Sometimes, from a small defect, the lesion spreads to underlying tissues, having the shape of a wedge, the base of which is directed to the serous membrane (Aschoff's primary affect). There is a moderate leukocyte infiltration of the submucosal layer. The muscular layer is not changed or changed slightly. The serous membrane contains a large number of dilated vessels, which can also be observed in the mesentery of the appendix. Occasionally, a clear, sterile reactive effusion occurs in the abdominal cavity.

Acute phlegmonous appendicitis characterized by a significant thickening of the appendix, edema and bright hyperemia of its serous membrane and mesentery. There are always fibrin overlays on the process, which can also be on the dome of the caecum, parietal peritoneum, adjacent loops small intestine(fig.43-2).

Rice. 43-2. Acute phlegmonous appendicitis (photo during surgery).

In the abdominal cavity, in most cases, an effusion is determined, often cloudy due to a large admixture of leukocytes. The effusion may be infected. The lumen of the appendix usually contains liquid, gray or Green colour pus. The mucous membrane of the appendix is edematous, it is easy to injure it; it is often possible to see multiple erosions and fresh ulcers (phlegmonous-ulcerative form of acute appendicitis). Microscopically, massive leukocytic infiltration is observed in all layers of the appendix, the integumentary epithelium of the mucous membrane is often desquamated, occasionally it is possible to see multiple primary Aschoff affects. In the mesentery of the appendix, there is a pronounced plethora and leukocyte infiltrates.

Empyema of the appendix- a kind of phlegmonous inflammation. With it, as a result of a cicatricial process or blockage with a fecal stone, a closed cavity filled with pus forms in the lumen of the process. The peculiarity of this form of appendicitis is that the inflammatory process rarely passes to the peritoneal cover. The vermiform appendix in empyema is bulb-shaped swollen and sharply tense, defining a clear fluctuation. Along with this, the serous membrane of the appendix looks like in the catarrhal form of acute appendicitis: it is dull, hyperemic, but without fibrin overlays. There may be a sterile serous effusion in the abdomen. When the appendix is opened, a large amount of fetid pus is poured out. Microscopically, in the mucous membrane and submucosal layer - a significant leukocyte infiltration, which decreases towards the periphery of the appendix. Typical primary affects are rarely seen.

Gangrenous appendicitis characterized by necrotic changes in the appendix.

Total necrosis is relatively rare; in the vast majority of cases, the necrosis zone covers only a relatively small part of the appendix. The fecal stones located in the lumen of the process contribute to the necrosis of the wall and foreign bodies. The macroscopically necrotic area is dirty green, loose and easily torn, the rest of the appendix looks the same as in phlegmonous appendicitis. On the organs and tissues surrounding the inflamed appendix, there are fibrinous overlays. The abdominal cavity often contains a purulent effusion with a fecal odor and growth of typical colonic microflora on culture. Microscopically, in the site of destruction, the layers of the appendix cannot be identified, they look like a typical necrotic tissue, in the remaining parts of the appendix, a picture of phlegmonous inflammation is observed.

In the elderly, the so-called primary gangrenous appendicitis associated with atherothrombosis a. appendicularis. In essence, there is an infarction of the appendix, which directly turns into gangrene of the appendix, bypassing the catarrhal and phlegmonous stages of acute appendicitis.

If gangrenous appendicitis is left untreated, perforation occurs ( perforated appendicitis). At the same time, the contents of the appendix are poured into the abdominal cavity, as a result of which purulent peritonitis occurs, which can subsequently either be limited (formation of an abscess) or go into diffuse peritonitis. Macroscopically, the appendix during perforation differs little from that during gangrenous form acute appendicitis. Areas of necrosis of the same dirty green color, in one or more of them there are perforations, from which fetid, often ichorous pus pours out. The surrounding peritoneum is covered with massive fibrin deposits. The abdominal cavity contains abundant purulent effusion, sometimes - fecal stones that have fallen out of the appendix.

The course of the disease

The catarrhal stage of acute appendicitis most often lasts 6-12 hours. Phlegmonous appendicitis usually develops 12 hours after the onset of the disease, gangrenous - after 24-48 hours.

Perforation of the appendix with progressive appendicitis occurs, as a rule, after 48 hours. The indicated terms are typical for most cases of progressive acute appendicitis, but they are not absolute. AT clinical practice often observe certain deviations in the course of the disease. In this case, they mean only the typical development of acute appendicitis, when the process progresses and does not tend to reverse development.

Purulent peritonitis developing as a result of destructive appendicitis is the cause of severe abdominal sepsis and the main cause of deaths. With phlegmonous appendicitis, characterized by prolapse of fibrin, the greater omentum and loops of the small intestine can be soldered to the appendix, forming an appendicular infiltrate that delimits the inflammatory process from the free abdominal cavity. In the future, the infiltrate either resolves, or suppuration occurs - a periappendicular abscess is formed. In the case of a retroperitoneal location of a destructively altered appendix, a retroperitoneal phlegmon develops. Purulent exudate in the abdominal cavity can be encapsulated (both before and after appendectomy), which leads to the development of abscesses of various localization: pelvic, interintestinal or subdiaphragmatic. Extremely rarely occurs pylephlebitis - purulent thrombophlebitis of the portal vein.

B.C. Saveliev, V.A. Petukhov

Surgical diseases Tatyana Dmitrievna Selezneva

LECTURE No. 8. Appendicitis

Acute appendicitis is literally an inflammation of the appendix. The appendix arises from the posterior-internal segment of the caecum at the point where the three band muscles of the caecum begin. It is a thin convoluted tube, the cavity of which on one side communicates with the cavity of the caecum. The process ends blindly. Its length varies from 7 to 10 cm, often reaching 15 - 25 cm, the diameter of the channel does not exceed 4 - 5 mm.

The appendix is covered on all sides by the peritoneum and in most cases has a mesentery that does not prevent its movement.

Depending on the position of the caecum, the appendix can be located in the right iliac fossa, above the caecum (with its high position), below the cecum, in the small pelvis (with its low position), together with the caecum among the loops small intestine in the midline, even in the left side of the abdomen. Depending on its location, an appropriate clinic of the disease arises.

Acute appendicitis- non-specific inflammation of the appendix caused by pyogenic microbes (streptococci, staphylococci, enterococci, coli and etc.).

Microbes enter it by enterogenous (the most frequent and most likely), hematogenous and lymphogenous route.

On palpation of the abdomen, the muscles of the anterior abdominal wall tense. Pain at the site of localization of the appendix during palpation is the main, and sometimes the only sign of acute appendicitis. To a greater extent, it is expressed in destructive forms of acute appendicitis and especially in perforation of the appendix.

Early and no less important feature Acute appendicitis is a local tension of the muscles of the anterior abdominal wall of the abdomen, which is more often limited to the right iliac region, but can also spread to the right half of the abdomen or throughout the entire anterior abdominal wall. The degree of tension of the muscles of the anterior abdominal wall depends on the reactivity of the body to the development of the inflammatory process in the appendix. With reduced reactivity of the body in malnourished patients and the elderly, this symptom may be absent.

If acute appendicitis is suspected, vaginal (in women) and rectal examinations should be performed, in which pain in the pelvic peritoneum can be determined.

An important diagnostic value in acute appendicitis is the Shchetkin-Blumberg symptom. To define it right hand gently press on the anterior abdominal wall and after a few seconds tear it off the abdominal wall, while sharp pain or a noticeable increase in pain in the area of \u200b\u200bthe inflammatory pathological focus in the abdominal cavity. With destructive appendicitis, and especially with perforation of the appendix, this symptom is positive throughout the right side of the abdomen or throughout the abdomen. However, the Shchetkin-Blumberg symptom can be positive not only in acute appendicitis, but also in other acute diseases of the abdominal organs.

The symptoms of Voskresensky, Rovsing, Sitkovsky, Bartomier-Mikhelson, Obraztsov have a certain significance in the diagnosis of acute appendicitis.

With a symptom Resurrection pain appears in the right iliac region when the palm is quickly held through the patient's tight shirt along the front wall of the abdomen to the right of the costal edge down. On the left, this symptom is not defined.

Symptom Rovsing and is caused by pressure or pushes with the palm of the left iliac region. At the same time, pain occurs in the right iliac region, which is associated with a sudden movement of gases from the left half of the large intestine to the right, as a result of which oscillations of the intestinal wall and the inflamed appendix occur, which are transmitted to the inflammatory-altered parietal peritoneum.

With a symptom Sitkovsky in a patient lying on his left side, pain appears in the right iliac region, caused by tension of the inflamed peritoneum in the region of the caecum and mesentery of the appendix due to its marking.

Symptom Bartomier - Michelson- pain on palpation of the right iliac region in the position of the patient on the left side.

Symptom Obraztsova- pain on palpation of the right iliac region at the time of raising the straightened right leg.

A critical and objective assessment of these symptoms expands the possibilities of establishing a diagnosis of acute appendicitis. However, diagnosis this disease should not be based on one of these symptoms, but on a comprehensive analysis of all local and general signs of this acute illness abdominal organs.

For the diagnosis of acute appendicitis great importance has a blood test. Changes in the blood are manifested by an increase in leukocytes. The severity of the inflammatory process is determined using a leukocyte formula. The shift of the leukocyte formula to the left, i.e., an increase in the number of stab neutrophils or the appearance of other forms with a normal or slight increase in the number of leukocytes, indicates severe intoxication in destructive forms of acute appendicitis.

There are several forms of acute appendicitis (according to histology):

1) catarrhal;

2) phlegmonous;

3) gangrenous;

4) gangrenous-perforative.

Acute appendicitis is an inflammatory process that has developed in the appendix of the caecum, which can have several morphological varieties. Today, any of them is an indication for urgent surgical intervention.

Causes and pathogenesis of appendicitis

The cause of gangrenous appendicitis may be thrombosis of the appendicular artery, which is more common in patients with diabetes mellitus, as well as in the elderly.

Morphological picture of acute appendicitis

To date, experts distinguish between two main forms of acute appendicitis - simple and destructive. Destructive, in turn, is divided into phlegmonous, gangrenous and perforated appendicitis.

1. Simple catarrhal appendicitis is characterized by a thickening of the process and its infiltration with leukocytes. In the patient's blood, typical laboratory signs of an inflammatory process are found, such as leukocytosis, an increase in erythrocyte sedimentation time, a shift leukocyte formula to the left.

2. For phlegmonous form appendicitis is characterized by the presence of purulent discharge in the intestinal lumen, as well as more pronounced local changes, signs of ulcerative defects on the surface of the appendix.

3. Appendicitis is considered gangrenous, in which the appendix undergoes oxygen starvation and the appearance of areas of necrotic tissue. Outwardly, necrosis looks like dirty green or brown areas on the surface of the appendix.

4. Perforated appendicitis occurs when high blood pressure inside the clogged process, when the necrotic area is simply squeezed out into the abdominal cavity. Its infected contents are also poured there, causing severe purulent peritonitis.

Under certain conditions, sometimes there is a delimitation of the inflamed appendix with the formation of an infiltrate of the iliac region. This is the so-called "chronic appendicitis", which is treated conservatively at the initial stage.

Symptoms of appendicitis

The symptoms of acute appendicitis are dependent on each specific form of the disease, but the onset of the inflammatory process is usually similar. Patients note moderately severe pain in the upper abdomen (epigastrium), which gradually descends, localizing already in the right iliac region - the so-called "pain transfer" symptom, or the Kocher-Wolkovich symptom. This symptom occurs in about half of the cases.

Often, pain in appendicitis can initially disturb the navel or immediately in the right iliac region. In this case, the pain, as a rule, does not radiate, intensifying as the disease develops. At the final stages of necrotizing appendicitis, the pain syndrome decreases with the preservation of all other clinical and laboratory signs. This only indicates that areas with nerve endings also entered the ischemia zone.

Nausea and vomiting join a little later. In some cases, diarrhea or constipation is noted, the temperature may be subfebrile in nature or rise to extremely high numbers. There are phenomena of general intoxication.

An objective examination shows local tension in the muscles of the anterior abdominal wall.

are revealed positive symptoms appendicitis:

Symptom of Razdolsky- pain in the right iliac region during percussion;

Symptom Sitkovsky- the appearance or intensification of pain in the right iliac region in the position on the left side;

Symptom of Bartomier-Michelson – the appearance or intensification of pain in the right iliac region in the position on the left side during palpation of the caecum;

Rovsing's sign- press down with one hand sigmoid colon blocking the light. Somewhat proximal to this place, jerky movements are performed with the free hand in the projection of the ascending colon in the direction of the left hypochondrium. A symptom is considered positive with increased pain in the right iliac region;

Symptom of Resurrection II, or "shirt symptom". With one hand pull the shirt of the patient. The fingers of the free hand make superficial movements in the direction from the epigastrium to the projection of the caecum. Increased pain is a sign of peritoneal irritation;

Shchetkin-Blumberg symptom- after light pressure in the right iliac region, quickly remove the hand from the abdomen. A sharp increase in pain at this moment indicates the development of peritonitis in a patient;

Obraztsov's symptom with the retrocecal location of the appendix, pain from pressure with a hand in the projection of the caecum increases while raising the straightened right leg.

With an atypical location of the appendix clinical picture changes, making it difficult to diagnose acute appendicitis. The appendix can be located subhepatic, retrocecal, lateral, medial. With the pelvic location of the process, appendicitis simulates diseases of the urinary-genital area and requires consultation with a gynecologist, urologist with additional methods research.

An even rarer case is such an anomaly as transposition internal organs. In this case, the appendix, and hence all the symptoms, are shifted to the left iliac region.

Complications of acute appendicitis

appendicular infiltrate,
appendicular abscess,
perforation of the appendix,
abscess small pelvis,
pylephlebitis (purulent inflammation of the portal vein),
peritonitis,
sepsis,
retroperitoneal phlegmon,
thrombosis of the veins of the small pelvis.

Treatment of acute appendicitis

At the present stage of development of medical science conservative treatment acute appendicitis in most cases is not possible. Therefore, if this disease is suspected, the patient is unconditionally hospitalized in a hospital for an operation - an emergency appendectomy. The diagnosis is made clinically, on the basis of complaints, anamnesis, and objective examination data. An auxiliary method is the presence of leukocytosis in general analysis blood. If the surgeon has doubts, it is possible to dynamically monitor the patient for no more than 2 hours with a re-evaluation of symptoms and changes in the general blood test. In difficult cases, confirm or refute the diagnosis allows diagnostic laparoscopy.

Appendectomy for uncomplicated course is performed from a small (usually up to 10 cm) incision in the right iliac region. Visualize the inflamed appendix, cross the mesentery, and then the appendix itself. Sometimes this manipulation is performed simultaneously. The stump of the process is immersed inside the caecum with a purse-string suture and additionally strengthened from above with a Z-shaped suture. After sanitation of the abdominal cavity, the wound is sutured in layers. With moderate inflammation and a small amount of exudate, the abdominal cavity is not drained. The stitches are usually removed on the 7th day.

Appendectomy can be performed laparoscopically, which will reduce the length of the patient's stay in the hospital.

With a diagnosed appendicular infiltrate, the patient is treated conservatively. A planned operation is performed after 2-6 months.

In case of perforation of the appendix, diffuse peritonitis, a median laparotomy, sanitation and drainage of the abdominal cavity are performed. Antibiotics and detoxification therapy are prescribed intraoperatively and subsequently.

Before being examined by a doctor, it is forbidden to perform anesthesia by any means, or to attempt to clean the intestines with an enema. This can lead to "lubrication" clinical manifestations illness, late admission to the hospital, or, as for the enema, even greater compression and perforation of the walls of the appendix.

Sometimes you can hear about cases of successful treatment of appendicitis. folk methods. However, we have not come across reliable cases of such miraculous healings. Instead, there are many reported facts of deaths due to delay in the operation, the development of peritonitis, septicotoxemia, infectious-toxic shock. Therefore, we want to warn you against attempts of independent, incompetent treatment of such a simple at first glance, but so serious in reality, disease as acute appendicitis. It is always better to turn to specialists in time!

If appendicitis is diagnosed, surgery is inevitable. Surgery on the appendix is the only way to combat inflammation of this organ.

The success of the operation depends on the timely visit to the doctor, the qualifications of the doctor, the equipment of the clinic, as well as the implementation of the doctor's recommendations during the recovery period.

The problem is signaled by pain in the lower abdomen, which does not stop for 3-4 hours. These symptoms are not unique to appendicitis. With colic in the abdomen, you should immediately consult a doctor.

The surgeon conducts an accurate diagnosis based on patient interviews, palpation of the abdominal cavity, and examination of test results. Pain with an inflamed appendix can be felt not only in the lower abdomen, but also under the ribs, in the back.

Inflammation of the intestines has similar symptoms, only a doctor can make an accurate diagnosis.

When removing appendicitis, the operation takes place in several stages.

Patient preparation.
The actual operation.
Patient recovery.

Depending on the circumstances, the manipulation to remove the process is carried out in an emergency mode or in a planned manner.

Before the procedure, additional examinations are made: ultrasound, tomography, radiography of the abdomen, which allow clarifying the diagnosis, detecting the focus of inflammation.

Operations to remove appendicitis are performed with a dissection of the peritoneum or point piercing (laparoscopy). The second method is more gentle, since appendicitis is cut out without opening the abdominal cavity. After such manipulation, patients quickly return to the normal rhythm of life.

Preparing for the operation

Appendectomy (removal of the appendix) is considered an emergency operation. The preparation of the patient is carried out as quickly as possible. The anesthesiologist examines the condition of the heart and vascular system the body's response to different kinds anesthesia.

Based on the data obtained, selects anesthesia. To cleanse the stomach and intestines, appropriate procedures are carried out.

Before surgery to remove the appendix, hairy areas are shaved. The skin is degreased and disinfected.

If a surgical intervention is planned, a conversation is held before it with the patient and loved ones about the method of pain relief, postoperative complications. In extreme circumstances, an operation to remove an appendicitis is performed without a preliminary conversation. In such cases, classical surgery is performed.

This allows you to quickly eliminate possible complications among which the most serious is peritonitis. If there is a rupture of the appendix, and pus is in the abdominal cavity, the clock counts.

Removal with dissection of the abdominal cavity

There is no standard for how long an operation to remove an appendix takes. The duration depends on the patient's state of health, the stage of the inflammatory process, and other indicators.

Anesthesia

Means for relieving pain are chosen depending on the age of the patient, the presence of allergic reaction for drugs, individual characteristics organism. Physicians perform anesthesia in three ways:

under general anesthesia: complete anesthesia when the patient's consciousness is turned off;
conduction blockade: the introduction of anesthesia into the space around the nerve bundle, the doctor must be well aware of the location of the nerve nodes and the injection site of the needle;
tight infiltration: the creation of a novocaine layer under the site of intervention. To do this, a 25% solution of novocaine is injected into the cavity with a syringe and pain impulses are blocked. It is necessary to inject novocaine several times during the operation.

With blockade and tight infiltration, the patient is conscious. These methods are not used when removing appendicitis in a number of cases:

with laparoscopy;
for emotional people with high excitability;
for operating children;
with peritonitis.

During surgical intervention the anesthesiologist controls the work of the vital organs of the operated person.

Operation progress

Removal of the appendix is carried out according to a strict algorithm:

The introduction of anesthesia to the patient.
Dissection of the peritoneum.
Inspection of the inflamed process, intestines, internal organs.
Removal of the appendix.
Edge processing.
The imposition of catgut in the abdominal cavity (sutures that do not require removal).
Skin tightening and upper sutures, followed by removal.

If pus enters the peritoneum, the abdominal cavity is sanitized. To remove it, install a drain. Remove the device after bringing the patient to a stable condition.

Postoperative period

the patient after the appendix has been cut out is no less important than the operation itself. Full rehabilitation of the patient takes up to six months.
After any type of surgical intervention, the patient is prescribed antibiotics. They eliminate inflammatory processes in the body and prevent the formation of new ones. Although the patient may feel well, a full course of antibiotic therapy is necessary.
After removal of the appendix, all patients are shown. Compliance proper diet and diet is considered necessary condition health recovery. After manipulation, the intestine slowly restores its usual functions. It takes time to get things back to normal. load on digestive organs increase gradually.

Additional stress for the digestive system is taking antibiotics. Under the influence of drugs, the intestinal microflora is disturbed. This leads to failures in the digestion and assimilation of food. To avoid negative consequences, you need a diet and special drugs. The doctor prescribes medications that support the microflora.
AT postoperative period reduce . Immediately after the appendix is cut out, the patient is taught to get out of bed correctly. Sudden movements lead to a violation of the integrity of the seams. However, absolute rest leads to the appearance of adhesions. Therefore, in order to avoid problems, the patient is taught to move correctly.
In the first days after the intervention, short slow walks are necessary. Duration and pace are determined by the doctor. At the slightest ailment, the patient should consult a doctor.

An important issue is hygiene procedures. Bathing or showering should be done after consulting your doctor. In the first days after the operation, such procedures are unacceptable. After removing the stitches, they are limited to a shower. Taking a bath during this period should be postponed.
After the sutures are completely healed, increase physical exercise. However, this should be done gradually: you can not lift weights, run, jump. You should visit your doctor periodically. This will allow you to control the recovery process and avoid complications.

Pros and cons of abdominal surgery

The main advantage of standard appendicitis surgery is that it resolves the inflammation quickly.

The disadvantages of cutting the abdominal cavity include:

duration of the procedure;
the risk of adhesion formation;
prolonged stay of the patient in the hospital;
painful rehabilitation process;
high probability of suppuration of the seams;
the presence of scars on the body.

Laparoscopy

Knowing about the problems that arise during abdominal operations, doctors are increasingly inclined to perform intervention through punctures in the abdomen.

Relatively new. An operation on appendicitis by a point method is performed in the following cases:

the patient has diabetes;
with obesity II - III degree;
to confirm the diagnosis of acute appendicitis.

Point surgery for appendicitis is contraindicated in cardiovascular diseases, diseases of the respiratory organs, complications of appendicitis.

There is no consensus on whether it is worth doing laparoscopy with a complicated appendix, namely its rupture. Although surgeons are highly experienced in successfully performing such operations, most experts believe that in difficult situations, the patient should be operated on in the usual way.

Operation progress

The skin surface for laparoscopy is prepared in the same way as in the standard procedure. Evacuation of food from the stomach in this situation is optional, since an incision in the abdominal cavity is not performed. But it is worth considering that it is better to come out of anesthesia with an empty stomach.

Removal of appendicitis by laparoscopy is performed under general anesthesia. The patient makes 3 incisions in:

the navel area (for the introduction of a video camera);
the focus of inflammation identified during the examination;
lower left abdomen.

The diameter of the incisions is 5-10 mm. Using a video camera, doctors examine the abdominal cavity. The image is sent to the monitor. The algorithm of actions is as follows:

An inflamed appendix is found.
They tie him up.
Cut out.
Exit through the hole.
Sew up the incisions.

During laparoscopic operations to remove the appendix after insertion of the camera, it may be found that the preliminary diagnosis is incorrect. This is possible, since the symptoms of the pathology have similar signs with other diseases, for example, gynecological diseases (ovarian problems). In this situation, appendicitis is not excised, the operation is completed.

Postoperative period

Since during point manipulation abdomen is not opened, there are no problems in the postoperative period. Patients tolerate the procedure well. The patient returns home after 1-2 days. The sutures are removed 7 days after the intervention.

Rehabilitation of the body after a point removal of appendicitis can last a month. With this operation, there is no need for a special diet. The patient should monitor the condition of the punctures. They shouldn't diverge. You should consult with your doctor about how to take a shower or bath.

Regardless of the method of removal of the appendix, patients find it difficult to get out of general anesthesia. The process is often accompanied by nausea, vomiting, painful sensations. In such a situation, you should contact the nurse for help. Special preparations allow you to quickly eliminate the problem.

Pros and cons of laparoscopy

Removal of appendicitis through small incisions has a number of positive factors:

instead of an incision, punctures are made, it is less traumatic;
visual diagnostics is carried out with the help of a video camera;
the possibility of adhesions is excluded;
after the operation, only small scars remain on the body;
after excision of appendicitis, the patient quickly recovers and stays in the clinic for no more than two days.

Only the doctor decides which operation to remove appendicitis is indicated for the patient. The procedure will pass without complications if you follow the doctor's recommendations at each stage. After discharge from the clinic, you should visit a doctor for a routine examination and prevent possible complications.