The treatment for acute appendicitis is removal of the appendix.
This may be performed in two ways:
Open surgery - The incision is sited over the expected position of the appendix, on the right lower part of the abdomen.
The appendix is removed having first divided its blood supply.
The advantages of this procedure is that it provides training to the junior surgeon in all phases of an abdominal operation. The surgeon must be adept at making incisions, handling the bowel and safely securing blood vessels.
The disadvantage is that the diagnosis may be in some doubt and a thorough examination of the peritoneal cavity is difficult through this incision.
Large abdominal wounds are painful and discharge delayed following the operation.
Laparoscopically - A camera is inserted initially through the umbilicus
and the abdominal contents examined. Alternative diagnoses may be made at this
stage.
Camera ports and operating ports are inserted at the points of preference of the surgeon and the appendix divided at the point it joins with the caecum.
It is then removed from the abdomen via one of the ports.
Recovery is often quicker by this method as the patient has 3 tiny wounds instead of one large incision.
The disadvantage of this procedure is that a large, gangrenous appendix may
be difficult to extract from the abdomen without enlarging one of the incisions.