Appendectomy - Appendix Surgery in Hyderabad, India | Cost & Procedure Benefits

Preparation for the appendix surgery - before and after

In order to assure safety and efficacy, there are usually a few crucial stages involved in preparing for appendicitis surgery. Here’s a general outline of what to expect:

Prophylactic antibiotic therapy

• Administration of prophylactic antibiotics is crucial before an appendectomy to prevent postoperative infections and intra-abdominal abscesses. These should be given within 60 minutes of the procedure for maximal effectiveness. A broad-spectrum antibiotic is recommended, targeting gram-negative bacteria (including Pseudomonas aeruginosa and resistant Enterobacteriaceae), enteric streptococci, and anaerobes. 

For patients without penicillin or cephalosporin allergies:

• A unit dose of cefotetan or cefoxitin via intravenous route, or
• Combinational drug approach with metronidazole and cefazolin via intravenous.

For patients with penicillin or cephalosporin allergies:

• Combination therapy with intravenous clindamycin and either levofloxacin, ciprofloxacin, gentamicin, or aztreonam.
• Post-culture adjustments should be made based on sensitivity results.

Fluid resuscitation

• IV fluids are often given to maintain hydration, especially if the patient finds difficulty in eating or drinking associated with the pain. 

Patient draping 

• The patient is supposed to be in supine position with his/her left arm tucked. However, the Trendelenburg position after placement of the ports provide enhanced visibility and access.
• A sterile surgical field that extends laterally to the left and right sides and inferiorly to the pubic tubercle is formed, starting superior to the bilateral costal margins. It should be feasible to convert the sterile field to an open operation.

Abdominal access

• Abdominal access can be achieved using the periumbilical Hasson technique, Veress needle, or optical trocar, depending on the clinical situation and surgeon's preference.

Abdominal insufflation and port placements

• The peritoneal cavity is insufflated using Hasson technique or Veress needle with carbon dioxide gas by inserting a 5-mm angled laparoscope, and two 5-mm ports under direct visualization.
• Optical trocars are placed periumbilically in the lower right quadrant with a 5 mm port and another in the left iliac fossa.
• A third trocar for appendiceal anatomical variations can be considered if required, including a subhepatic appendix. 

During Appendectomy Procedure

• The abdomen is thoroughly examined overall, before focusing on the lower right quadrant. The omentum and small bowel are swept towards the head of the appendix, and the terminal ileum can be identified using Treves or antimesenteric fat. 
• Proper patient positioning is crucial for appendix identification. The preferred approach for subserosal appendix patients is a complete, meticulous dissection of the visceral peritoneum.
• Inflammatory adhesions between appendix, small bowel, and cecum can be divided using blunt dissection, with sharp dissection potentially needed. Electrocautery should be avoided to prevent contact and conductive injury.
• If the visualization or dissection of the appendix is suboptimal, it may be beneficial to consider converting to an open procedure.
• The appendix tip can be visualized and elevated off the cecum using a Maryland dissector. A window is created between the mesoappendix and appendix base, with the appendix and mesoappendix parallel to the lateral abdominal wall for a safer bowel injury orientation.
• The mesoappendix is divided using an endoscopic stapler loaded with vascular staples, and the appendix at its base is divided using a second load of vascular staples, ensuring the stapler is brought together close to the cecum.
• After the appendix has been removed, it is placed in an endoscopic retrieval bag and pulled out via the umbilical port.
• The bowel is swept caudally to return it to the lower abdomen and drape the omentum over the small bowel and appendiceal stump.
• The laparoscope is inserted through the midline port to ensure hemostasis of the anterior abdominal wall.
• Open accessory port sites can reduce needle stick risk, procedure length, and cost without increasing port-site hernia incidence rates compared to fascial closure and the skin is closed. 

After appendectomy procedure

• The patient will be monitored for vital signs, including temperature, blood pressure, pulse, and respiration, and level of wound and pain intensity.
• The patient might be prescribed with painkillers. If no complications occur, patients can leave the hospital soon, with early movement recommended. However, caution is needed for climbing stairs to avoid straining abdominal muscles.
• After the operation, patients should be able to eat in 24 hours. Uncomplicated appendectomy patients typically leave the hospital two to three days after surgery.
  

Issues after appendix removal surgery, like wound infections and intra-abdominal abscesses, are the most frequent complications. In individuals with uncomplicated appendicitis, surgical site infections are very uncommon, although they can happen in as many as 10% of instances when the appendix was perforated.

• Wound infection: Wound infections after appendectomy can be superficial, or deep, with preoperative antibiotics, wound scrubbing, and irrigation reducing the risk of such wound infections. Laparoscopic appendectomy reduces incision site infection risk but pose greater risk of intra-abdominal and pelvic infections.
• Pelvic abscess: Almost, 9.4% of complicated appendectomy patients develop postoperative pelvic abscesses. Various measures, including intraoperative peritoneal irrigation, have been recommended to treat, but with conflicting outcomes and no proven effective intervention.
• Stump appendicitis: Stump appendicitis, a recurrent form of appendicitis, occurs when insufficient appendiceal tissue is resected, often in cases of perforated appendicitis, and minimizing risk requires resection of adequate tissue with less than 5 mm preservation.
  

Life after appendectomy (appendix surgery)

The appendix is often considered a redundant organ because the human body can function perfectly well without it. Once the appendix is removed, there is no chance of experiencing appendicitis again because the entire organ has been taken out. Recovering from an appendectomy typically involves a gradual return to normal activities. Most patients can expect the following:

• Initial Recovery: After surgery, patients may experience some pain and discomfort, which can usually be managed with prescribed pain medications. Rest is essential during the first few days.
• Diet: Many people can start eating solid foods within a few hours after surgery, but it's advisable to start with light meals and gradually return to a normal diet as tolerated.
• Activity Level: Light activities can often be resumed within a few days, but strenuous exercise or heavy lifting should be avoided for several weeks to allow the body to heal.
• Follow-Up Care: A follow-up appointment with the surgeon is typically scheduled to ensure proper healing and address any concerns.
• Watch for Complications: While complications are rare, it’s important to monitor for signs of infection, excessive pain, or other unusual symptoms, and to contact a primary care doctor / surgeon if any arise.

Overall, most individuals return to their normal routines within a few weeks, feeling relieved and free from the discomfort caused by appendicitis.

Here are some questions patients can ask before appendectomy:

• What type of appendectomy do you recommend for my case, and why?
• What are the potential risks and complications associated with this surgery?
• How should I prepare for the surgery, and are there any specific instructions I need to follow?
• What can I expect during the surgery, and how long will it take?
• What type of anesthesia will be used, and what are the risks associated with it?
• What will my recovery process look like, and how long should I expect it to last?
• Are there any specific symptoms I should watch for after the surgery that might indicate a problem?
• When can I return to my normal activities, including work, exercise, and diet?
• Will I need any follow-up appointments after the surgery, and what will they involve?
• What are the chances of experiencing complications in the future, such as infections or recurrence?
  

Appendectomy vs Appendicectomy

These two terms are predominantly used to describe the surgical procedure for removing the appendix: appendectomy and appendicectomy. Although these terms convey the same meaning, their usage varies based on regional language preferences.

• Appendectomy: This term is widely used in American English and is readily recognized in the medical community within the United States. It refers to the surgical removal of the appendix.
• Appendicectomy: Conversely, this term is more commonly employed in British English and is used in countries that adhere to British English conventions. It also denotes the surgical excision of the appendix, similar to appendectomy.

In essence, both appendectomy and appendicectomy describe the same surgical intervention, with their primary distinction rooted in regional linguistic preferences.