Laparoscopy appendicitis: surgery, recovery, diet
Acute appendicitis is a common disease at any age period, associated with the development of inflammation of the Appendix and requires surgery to remove it. While laparoscopy in appendicitis is the «gold» standard for diagnosis and removal of the Appendix, combining high security for the patient, minimal invasiveness and a high level of efficiency without the risk of serious postoperative complications. Proper operation allows you to quickly identify the nature of the disease and by laparoscopy to remove the Appendix.
Acute appendicitis is an inflammatory disease that affects the Appendix (vermiform Appendix) that can develop at any age. As a rule, the disease begins acutely painful attack in the right lower abdomen. This inflammatory process occurs first in the mucosa of the Appendix, and then it goes to all the other layers, which leads to the appearance of all clinical symptoms. Inflammation itself is not dangerous, however, appendicitis is an important measure to prevent serious complication – peritonitis, characterized by spread of the inflammation to the abdominal wall. Than before will be deleted changed as a result of inflammation of the Appendix, the better the prognosis for recovery after treatment.
Laparoscopy for appendicitis it is used to diagnose acute and chronic forms. As a rule, the confirmation of this diagnosis is a direct indication for surgical intervention. The main purpose of all types of operative intervention in acute appendicitis is removal of the inflamed vermiform Appendix. Thus there are two main approaches to treatment:
- using a wide access and cut the anterior abdominal wall.
- with the use of endoscopic laparoscopy, allowing to inspect and remove the Appendix through a small puncture in the abdominal wall.
Laparotomy used for the classical removal of the Appendix, is a large surgical intervention with the application of incision of the anterior abdominal wall 8-15 cm long While the surgeon gets the opportunity of wide access to the affected organ and can perform an appendectomy, i.e., to remove the Appendix. Such surgical interventions require a longer recovery period of the patient and lengthen the time how much the patient to stay in hospital.
During a laparoscopy through a small puncture in the abdominal cavity are introduced laparoscopic instruments and the laparoscope, allowing you to visually control the progress of the operation. This operation reduces the duration of hospitalization of the patient and facilitates the postoperative period, slimming and cosmetic defects, as it doesn’t leave a big scar.
Laparoscopy for appendicitis – the «gold» standard of diagnosis and surgical treatment of acute appendicitis.
The main advantages of laparoscopic appendectomy following:
- Reducing the intensity and duration of pain.
- More rapid recovery of the functions of internal organs (peristalsis small and large intestine, etc.).
- Reducing length of stay in the hospital.
- Short period of disability of the patient.
- The lack of scarring after surgery.
It is important to note that, in the end, between laparotomy and laparoscopy makes the choice of the attending physician, who decides on the basis of the clinical picture of the disease and peculiarities of organism of the patient.
Indications and contraindications to the procedure
The main indications for laparoscopy and appendectomy by laparoscopy – symptoms of acute and chronic forms of appendicitis. On these conditions shows striking clinical picture and changes that are detectable with laboratory and instrumental methods of examination.
The list of contraindications is quite broad and includes both absolute and relative contraindications. To absolute are:
- Pregnancy in the later stages.
- The presence of contraindications to the use of anesthesia.
- Of blood coagulation disorders (hemophilia, etc. States with reduced blood coagulation).
- The absence of signs of inflammation of the Appendix.
- Diffuse purulent inflammation in the retroperitoneal region.
- Appendicular infiltrate, representing tightly soldered the Appendix with the bowel loops.
Relative contraindications include the following:
- The increased weight of the body, impeding the access into the abdominal cavity by laparoscopy.
- Past illnesses of the abdominal organs in connection with risk of development of adhesions.
- Peritonitis, as the optimal method of treatment when it is a wide laparotomy.
Required preparation for surgery
Conducting laparoscopic diagnosis and surgical treatment of acute appendicitis is always an emergency procedure, as the forecast for recovery depends on how much time a patient is having clinical manifestations of the disease.
The average duration of preparation for surgery takes 2 hours. At this time the patient spend infusion therapy and premedication before giving anesthesia. As a rule, laparoscopy for appendicitis does not require the use of special measures in preparation for surgery.
The main method of anesthesia patients is to give General anesthesia or spinal anesthesia, in which the patient retains consciousness. Initially in the abdominal cavity of the patient is administered a special needle the Veress by which it is injected carbon dioxide to increase the volume of the abdominal cavity and provide better visual monitoring of the progress of the operation.
In the study of the abdominal cavity by laparoscopy is very important to observe the procedure.
Introduction instrumentation is made through holes in the anterior abdominal wall, performed using a special trocar. The location of the points of punctures clearly defined standards of conduct such operations. Through the first puncture introduced laparoscope, which is a flexible probe with a camera and a light source at the end. With the help of his attending physician examines the Appendix and determines whether to continue the operation and how many instruments to remove the inflamed Appendix, he will need.
After the introduction of the laparoscopic surgical instrumentation, is carried out ligation of the Appendix at its base and remove. Upon completion of the operation the abdominal wall is sutured carefully in layers, and the abdominal cavity drainage installed to ensure the exit of the inflammatory fluid.
How long does laparoscopy for appendicitis with the removal of the Appendix? The average duration of this procedure is 1.5-2 hours, which is due to the necessary operation volume and the risk of developing complications.
As with any invasive procedure, laparoscopy and laparoscopic appendectomy, possible development of negative patient consequences. Distinguish between intraoperative and postoperative complications.
The former include:
- Damage to internal organs, primarily the loops of the intestine with the trocar and laparoscopic instrument.
- Bleeding from the vessels of the anterior abdominal wall.
- Violation of the integrity of the Appendix.
To postoperative complications include the following situations:
- Hemorrhage into the abdominal cavity.
- Failure of the stump of the Appendix.
- The development of purulent-inflammatory processes in the sutured holes in the abdominal wall and into the abdominal cavity.
- Hematoma in the subcutaneous tissue on the anterior abdominal wall.
- The possibility of formation of hernias in the area of application of the tools.
Prevention of these complications is carried out with adequate preparation of the patient, compliance with equipment procedures and recommendations for the postoperative period.
The postoperative period
Recovery after a laparoscopy and removal of the vermiform Appendix is an extremely important period. It is believed that the sooner the patient begins physical activity, the better the prognosis for the post-operative period. A few hours after recovering from anesthesia, the patient must start walking by adjusting exercise intensity and not perenapravit yourself. Gradually, the distance and the walking time increases.
Many patients are interested in the question how long does the period of hospitalization in laparoscopy? The necessary duration of a person staying in a hospital – one day, if was performed only laparoscopic study without surgical intervention.
It is very important to continue medical support of the patient, this often is used:
- infusion therapy;
- antibacterial drugs.
In the absence of secretions of abdominal cavity drainage can remove on the second or third day. On the first day after laparoscopy, the patient will refuse to eat, however, within the next two days you can have a meal specially cooked foods, they should not be hard, sharp or excessively hot.
On average, the patient is in the hospital after a laparoscopy one day, and after the removal of the Appendix by laparoscopic method is 2-3 days. In such cases many patients have time to recover during this period without the threat of late postoperative complications.
Laparoscopy for appendicitis is an excellent diagnostic method with the ability to quickly transition to a laparoscopic removal of the Appendix upon confirmation of the diagnosis of acute appendicitis. However, to increase the safety and efficiency of the procedure is recommended to adhere strictly to the available indications and contraindications to the study and to follow the standard to conduct such invasive procedures.