Appendectomy

Appendectomy requires general anesthesia, and typically hospitalization.

Approximately 250-300,000 appendectomies each year in the US.

The mean percentage of unnecessary appendectomies from clinical false-positive diagnosis of appendicitis is 20%.

Approximately  8% of adults with suspected appendicitis confirmed on CT scan have a normal appendix at operation.

Lifetime risk of undergoing an appendectomy is between 7 and 14%.

The 30 day case fatality rate with appendectomy among patients with uncomplicated appendicitis is approximately 0.5 per 1000.

The case mortality rate among the elderly persons is twice that of those among adolescents.

Men have a higher incidence of appendicitis.

In some high-risk populations, such as women of reproductive ages, the population-based rate of unnecessary appendectomy is as high as 26%.

Women at all ages and patients younger than 5 years and older than 60 years have a higher rate of negative appendectomy.

Associated with a sevenfold excess 30-day rate of death compared with the general population.

Associated with only 3 deaths per 1 million population per year.

Patients undergoing negative appendectomy have prolonged hospitalizations, increased infectious complications and higher rate of case fatality when compared to patients with appendicitis.

Laparoscopic appendectomy is now the most commonly use procedure, and perform in 60-80% of cases.

Laparoscopic appendectomy is associated with a shorter hospital stay of 1-2 days duration and the complication rate that is less than with an open surgery, between one and 3%.

The indications for laparoscopic appendectomy are identical to those for open appendectomy. 

 

 

Guideline lists the following conditions as suitable for laparoscopic appendectomy: 

 

Uncomplicated appendicitis

 

 

Appendicitis in pediatric patients

 

 

Suspected appendicitis in pregnant women

 

 

Laparoscopic appendectomy may be the preferred approach

 

 

Perforated appendicitis

 

 

Appendicitis in elderly patients

 

 

Appendicitis in obese patients

Patients with rupture and large abscess are usually  treated with antibiotics  and, if possible, undergo percutaneous drainage to avoid more extensive operations.

It has a relatively low risk.