Laparoscopy appendicitis: features and operation
One of the most common diseases is appendicitis, the inflammation of the end of the cecum called the Appendix, which is accompanied by severe pain, fever and changes in the blood. For the treatment should emergency surgical intervention, as delay threatens to peritonitis, perforation of the walls of the Appendix and the effusion of pus into the abdominal cavity.
Along with traditional surgery, patients may be asked to remove the Appendix laparoscopically. How does the removal of the Appendix by this method and how is the postoperative period?
Advantages of the laparoscopic method of removal of Appendix
This type of surgery allows the doctor to accurately diagnose the disease and to take action quickly to remove the Appendix. During the operation examines the abdominal cavity, small pelvis, the Appendix itself. This gives the opportunity to detect appendicitis, even if the location is non-standard.
Among the advantages of the method include such as :
- pain stop much faster;
- faster recovering work capacity;
- reduced the duration of hospital stay;
- faster resumes intestinal peristalsis;
- good aesthetic effect.
The disadvantages of the method
However, laparoscopic surgery is also not devoid of several drawbacks, such as:
- distortion of depth perception;
- dulling of tactile sensations, which complicates the diagnosis and operation;
- difficult to control the degree of application of force to the tools, making the manipulation of the bodies;
- limited space for management tools;
- impeding the process of cutting fabrics when manipulating instruments, which move in the opposite direction relative to the direction of movement of the arms.
Indications for laparoscopy
Laparoscopic surgery is performed in acute and chronic forms of appendicitis.
This type of surgery can also be carried out if you have symptoms of peritonitis. In severe cases, when symptoms of appendicular abscess or peritonitis held open surgery.
Conducting laparoscopic surgery for appendicitis in the chronic form shows only if the pain is persistent and pronounced.
A typical history with a characteristic systematic pain in the abdomen is also the indications for laparoscopy.
When laparoscopic appendectomy contraindicated?
Although laparoscopy is considered malotravmaticheskaya surgical intervention, in some cases, this method has contraindications that may be absolute and relative.
- the later stages of pregnancy;
- individual intolerance to anesthesia;
- violation of blood coagulability;
- the appearance of a dense infiltrate;
- the development of retroperitoneal phlegmon;
- in the Appendix there is no symptoms of inflammation.
- earlier surgical intervention;
- excess body weight;
- adhesions in the intestine;
- generalized peritonitis.
Preparations for the laparoscopy
The preparatory period for laparotomies Appendix surgery lasts about two hours. This is infusion treatment, preparation of the operated places and the introduction of antibiotics and sedative drugs. If the diagnosis «appendicitis in an acute form» been defined correctly, the preparation for surgery takes a minimum of time.
The course of laparoscopic appendectomy
Laparoscopy is performed under General anesthesia. In the navel a small incision is made where you enter the Veress needle. Through it, the abdomen is filled with carbon dioxide. This manipulation allows the surgeon to view internal organs.
The next stage of the operation, introduced a trocar, a surgical instrument designed to penetrate in a cavity of the human body through epithelial tissue with preservation of their integrity during manipulation of the laparoscope. This device gives you the opportunity to explore the abdominal cavity and to determine how the affected peritoneum, what are the changes in the intestine, as well as what form is the Appendix and where is it localized. After conducting such a diagnosis, the surgeon decides about the possibility of a laparoscopy. In the presence of at least one of the contraindications and the technical difficulties of the operation due to the possible risk of damage to healthy organ or bleeding shows only open surgery.
If contraindications to remove the Appendix by this method are not available, additional incisions are made above the pubic area and right under the ribs. The Appendix is fixed and inspected. In the place where the Appendix is connected to the caecum, with the help of special scissors made a hole through which the ligature is carried out for dressing of the folds and vessels of the peritoneum. Several ligatures overlap the next, and after 1-1,5 centimeter one more. The surgeon then cuts the Appendix between the ligature and remove the outside.
The final stage of removing the Appendix — conduct sanitation and drainage of abdominal cavity. Using the laparoscope, the surgeon examines the abdominal cavity. If the ulcers, they are devastated by the pumps.
What can be complications?
If during the diagnosis of the abdominal cavity, carried out at the initial stage of the operation, it was found that no contraindications to a laparoscopic appendectomy there, but there are intraoperative technical difficulties related to the probability of bleeding or perforation of a healthy colon in this case, it may be a transition to an open surgery. This can be in marked inflammation or the presence of adhesions in the region of the Appendix.
The postoperative period
The recovery period after a laparoscopy is faster, so in the physical activity of the patient practically without limit. After a few hours after the surgical intervention it is possible to get out of bed and even walk. But this does not mean that the patient can immediately load your body and carry weight.
Antibiotics and infusion treatment in the postoperative period should be continued. Also made bandages and remedial procedures. If necessary, the doctor may prescribe painkillers.
The next day after surgery, the patient can eat. Special nutrition in the postoperative period is not provided.
In the absence of complications on the second day after laparoscopy drainage can be removed. After 2-3 days the patient is transferred to outpatient treatment.
Within two months, the patient must refrain from heavy physical exertion.