Appendicitis

The first description of appendicitis was done by Reginald H. Fitz, which was an anatomopathologist from Harvard, that advocated early surgical interventions and it was done in 1886 but because of the fact that he was not a surgeon, his advice was ignored and studies never included such important information. The most common approach will remain open appendectomy because of the operative costs and time but from 1987, many surgeons changed their techniques, preferring laparoscopic appendectomy instead.

This type of surgical procedure has its advantages that will include a better aesthetic result, lower postoperative pains, faster healing and a quicker return to the usual activities and lower dehiscence and wound infections. Laparoscopic appendectomy will be more cost effective but will require more operative time in comparison with the open appendectomy procedure.

Nowadays studies show that a laparoscopic appendectomy will take only ten minutes longer then the open appendectomy approach leaving surgeons to choose the specific treatment that the patient will require, depending on the severity of the illness and history of the patient. Sadly, patients that undertook the open appendectomy has as an outcome a longer time needed to heal and several other post operative complications.

According to seventeen studies the average rate on hospital stays due to negative appendectomies and abdominal abscesses are similar. A patient that will suffer from appendicitis will require urgent help and treatment. The recommended choice in treating it will most always be an appendectomy, specifically in patients that have a history in continuous abdominal pain, clinical signs of diffuse or localized peritonitis, fever and the presence of leukocytosis.

In most cases there is a debate on performing an open appendectomy or a laparoscopic appendectomy. If the first one is preferred and the surgeon will find the appendix looking normal, he or she will be faced with a huge dilemma on removing or not the appendix.

The logic behind this is that the patient will have a scar from the right lower quadrant incision and in the future is the patient will get sick again, appendicitis will not be on the differential diagnosis because of it. At the arrival at the hospital, a clinical picture will be made in establishing the gravity of the situation and if that picture will prove to be unclear then a computed tomography scan will improve the diagnosis and fasten it.

If the patient’s pain will diminish during the stay at the hospital, a follow-up is required to establish the common ground of the pain and the best way to handle it. Such a procedure will require general anesthesia and studies show that the post operative pains are not that severe, a maximum of ten days of discomfort being noticed.

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