Appendectomy
With rare exceptions, the only effective treatment for acute appendicitis is appendectomy, the surgical removal of an inflamed vermiform appendix. Commonly performed in an emergency, this surgery aims to prevent imminent rupture or perforation of the appendix. When completed before these complications can occur, appendectomy is generally effective and uneventful. If the appendix ruptures or perforates before surgery, its infected contents spill into the peritoneal cavity, possibly causing peritonitis—the most common and deadly complication of appendicitis, with a mortality of 10%.
Procedure
With the patient under general anesthesia, the surgeon makes an incision in the right lower abdominal quadrant (using either a muscle-splitting, or gridiron, incision or a McBurney’s incision) to expose the appendix (called “open appendectomy”). He ligates the base of the appendix and places a purse-string suture in the cecum. Then he removes any excess fluid or tissue debris from the abdominal cavity and closes the incision.
The use of laparoscopy for diagnosis and removal of the appendix has become a safe and common approach. In the laparoscopic approach, the surgeon makes several small cuts in the abdomen, into which he introduces carbon dioxide (to inflate the abdominal cavity and facilitate visualization), a small camera, and the surgical instruments used to remove the appendix. This procedure reduces postoperative pain, allows faster recovery, and shortens the period of hospitalization.
If perforation occurs, the surgeon may drain the abdominal cavity by inserting one or more Penrose drains or abdominal sump tubes (or both) before closing the incision, or he may leave the incision open. The open incisional wound then heals by secondary intention through granulation and epithelialization.
Complications
An appendectomy usually causes few complications postoperatively if the appendix is removed before inflammation has progressed to the point of perforation. Although uncommon, infection at the surgical site or a paralytic ileus may occur. If the appendix has ruptured before surgery, requiring drainage postoperatively, complications are more likely. These include local or general peritonitis, paralytic ileus, intestinal obstruction, and secondary abscesses in the pelvis or liver or under the diaphragm.
Key nursing diagnoses and patient outcomes
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