Appendectomy

Appendectomy
Intervention
An appendectomy in progress
ICD-10-PCS	0DTJ?ZZ
ICD-9-CM	47.0
MeSH	D001062
MedlinePlus	002921
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An appendectomy (known outside the United States as appendisectomy or appendicectomy) is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. However, a 12-hour delay had no effect on outcomes, in a large retrospective study.

In one large observational study in 2003, 30-day mortality was 1.8% in an adult population.

Appendectomy may be performed laparoscopically (in minimally invasive surgery) or as an open operation. Laparoscopy is often used if the diagnosis is in doubt, or if it is desirable to hide the scars in the umbilicus or in the pubic hair line. Recovery may be a little quicker with laparoscopic surgery; the procedure is more expensive and resource-intensive than open surgery and generally takes a little longer, with the (low in most patients) additional risks associated with pneumoperitoneum (inflating the abdomen with gas). Advanced pelvic sepsis occasionally requires a lower midline laparotomy.

In general terms, the procedure for an open appendectomy is:

These incisions are placed for appendectomy: 1) McBurney's incision, also known as grid iron incision 2) Lanz incision 3) Rutherford morrision 4) Paramedian incision

Over the past decade, the outcomes of laparoscopic appendectomies have compared favorably to those for open appendectomies because of decreased pain, fewer postoperative complications, shorter hospitalization, earlier mobilization, earlier return to work, and better cosmesis. However, despite these advantages, efforts are still being made to decrease abdominal incision and visible scars after laparoscopy. Recent research has led to the development of natural orifice transluminal endoscopic surgery (NOTES). However, numerous difficulties need to be overcome before a wider clinical application of NOTES is adopted, including complications such as the opening of hollow viscera, failed sutures, a lack of fully developed instrumentation, and the necessity of reliable cost-benefit analyses.