Appendectomy

Appendectomy is a surgical technique by which the cecal appendix is ​​removed. The most frequent indication for appendectomy is acute appendicitis . Currently, minimally invasive surgery is an important tool in the diagnosis and treatment of patients afflicted with this condition.

Summary

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  • 1 Introduction
  • 2 History
  • 3 Clinical picture
  • 4 Complications
  • 5 Sources

Introduction

As soon as the diagnosis of acute appendicitis is defined, an appendectomy should be performed, since the results of the surgical intervention are related to the precociousness of the latter and with the evolution of the appendicular inflammatory process. It has its maximum incidence between 10 and 30 years of age.

This procedure is indicated, both in confirmed cases and in those in which it cannot be excluded from the differential diagnosis, since the morbidity and mortality caused by an examination of the abdomen, either through conventional laparotomy or videolaparoscopy They are appreciably smaller than those produced by allowing an inflamed appendix to evolve towards its more serious phases (gangrenous and perforated), especially in children and the elderly.

History

During the Middle Ages most of the areas of medicine remained very attached to the traditional approaches, however the anatomy began to become independent from the classical assumptions and at the end of the 13th century the regular practice of the dissection of corpses began in Bologna, what spread to other cities in Italy , France and Spain .

Although the first objective pursued was to understand more deeply the work of the Greek physician Galen, new treatises began to emerge and the discoveries and rediscoveries of matters that had been hidden by medieval obscurantism began to follow. This was the case with the appendix .

Although the first known drawings of the human appendix were made by Leonardo Da Vinci , the descriptions that gave this element the character of an organ for the first time are from 1521 and are attributed to the Bolognese doctor Giacomo Berengario Da Carpi , anatomist and professor of medicine. Likewise, in 1543 the Belgian Andreas Vesalius drew an appendix in his work “Acta Anatómica”.

A year later, the French philosopher, mathematician, and physician Jean François Fernel, from the court of Henry II of France, made the first description of appendicitis as a finding in a

Jean François Fernel

autopsy, work that was even published in a newspaper of the time.

Thanks to the resources that these professionals had, several doctors of European royalty continued working on this type of discovery in the following decades, until in 1732 Claudius Amyan, physician to Queen Anne of England and a surgeon at the Hospitals of Westminster and St. George performed the first known appendectomy in history, operating on an 11-year-old boy with a right inguinoscrotal hernia and fecal fistula, finding the perforated appendix.

Only 20 years later, in conclusion to the findings of an autopsy on a convict, German Lorenz Heister reported that the cecal appendix could present with primary acute inflammation. Later other scientists postulated that it was not enough to drain the right iliac fossa, but that it was essential to remove the appendix, observations that were confirmed by Francois Melier in 1827. From this moment on, the pathological picture became confusing, which generated quite contradictory works. about.

In 1886 at the first meeting of the Association of American Physicians in Washington, DC, Dr. Reginald H. Fitz, a professor of pathology at Harvard University, first used the term appendicitis. On this occasion, the doctor not only described the clinical characteristics of this condition, but also identified the appendix as the cause of a good part of the inflammatory pathology of the right lower quadrant of the abdomen and agreed to recommend its rapid removal.

In the following years, Thomas Morton of Philadelphia successfully diagnosed and surgically treated a case of acute appendicitis. Then, supported by Fizt’s concepts, in 1888 Charles Mc Burney , from New York, performed his first appendectomy for acute non-perforated appendicitis, an experience that was published the following year, in a work that describes the incision that bears his name and the point of increased painful sensitivity.

Since then, surgeons have continued to access the appendix through incisions in the abdominal wall, trying different methods, including pararectal ones, incorporating the laparoscopic approach to pathology in recent years.

Acute appendicitis is an inflammatory process of the cecal appendix and constitutes the most common cause of acute surgical abdomen and the surgical condition most frequently operated on in the emergency services, which is why the history of its treatment has been reviewed by various authors in the last century.

Once the need to remove the organ was determined when appendicitis presented, the mortality rate began to show a progressive decrease, going from 26.4 percent in 1902 to 4.3 percent in 1912 , to 1.1 percent in 1948, to 0.6 percent in 1963, a figure that remains to this day.

Clinical picture

Murphy’s Triad

  • Epigastric or periumbilical pain at the beginning, which is later located in the right iliac fossa.
  • Nausea and vomiting

Physical exam

  • Coughing pain
  • Pain on palpation and percussion in the right iliac fossa, more evident in the Mc Burney point

Other maneuvers

  • Rectal, vaginal, or one of them
  • Axillary and rectal temperature, giving value to the difference greater than 1ºC

Complementary studies

Clinical laboratory

  • Blood count
  • Cituria
  • Group and Factor
  • Other studies according to the patient’s condition and associated diseases

Imaging

  • Abdominal ultrasound
  • CT of the abdomen (in patients with diagnostic doubt and poor general condition in which a white laparotomy could be harmful)

Complications

Appendectomy for acute appendicitis is the most common emergency operation in surgical services, but it is not without complications caused by little-known factors, the determination of which could decrease morbidity and mortality from this cause. The early diagnosis of the disease and immediate appendectomy with an appropriate surgical technique prevent the appearance of postoperative complications and determine the success of the only effective treatment against the most common condition that causes the acute abdomen, on whose prognosis it largely depends and among others. factors, the preoperative evolution time and the phase in which the disease process is found when performing the intervention.

Complications of interventions for acute appendicitis are not uncommon, even though technological advances in surgery and anesthesiology and resuscitation minimize operative trauma, the existence of intensive care and intermediate care rooms, for the care of seriously ill patients and that increasingly potent antibiotics are used today.

The following are mentioned, among others: bloody serousness in the surgical wound due to foreign body or poor hemostasis, parietal and intra-abdominal abscesses, hemorrhage, phlebitis, epiploitis, intestinal obstruction, stercoracic fistulas, evisceration and eventration.

 

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