Our Summary

This research paper involves a survey of 540 members of the Swiss Surgical Society to understand how they treat appendicitis. The study focuses on the surgical techniques used, how the appendix stump is closed after removal, and the use of abdominal washout.

The survey found that 45% of surgeons responded (243 in total). Of these, 78% perform keyhole surgery (laparoscopic appendectomies) in children and 95% in adults. Only 3% use a method that involves a single incision.

When defining complicated appendicitis, most surgeons agreed that the presence of pus or stool in the abdomen, an abscess, or a ruptured appendix were indicators. However, only 16% considered an inflamed base of the appendix as a complication.

In terms of closing the stump of the appendix, 41% of surgeons use a loop of suture material (endoloops), 36% use a stapling device, and 20% use plastic clips in non-complicated cases. If the appendicitis is complicated, 82% of surgeons use a stapler.

Most surgeons (76%) do not dip the appendix stump into fluid to rinse it off. Only 24% of the surgeons wash out the abdomen with more than 1 liter of fluid, regardless of what they find during the surgery.

In conclusion, most Swiss surgeons prefer using multiple small incisions for appendicitis surgery. They mostly use loops of suture material and staplers to close the appendix stump in uncomplicated cases, and staplers for complicated cases. Very few surgeons rinse the appendix stump or routinely wash out the abdomen during the procedure.

FAQs

  1. What are the common methods of appendiceal stump closure used by Swiss surgeons?
  2. How often is the laparoscopic technique used in appendectomy procedures in Switzerland?
  3. What do Swiss surgeons consider as indicators of complicated appendicitis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about appendectomy is to follow post-operative care instructions carefully, including taking prescribed medications, avoiding strenuous activities, and watching for signs of infection such as fever or increased pain. It is important to follow up with the surgeon for any concerns or complications that may arise.

Suitable For

Patients who are typically recommended for appendectomy include those with acute appendicitis, especially if they have symptoms such as abdominal pain, nausea, vomiting, and fever. Complicated cases of appendicitis, such as those with abscess formation or perforation, may also require surgical intervention. In some cases, patients with a history of recurrent appendicitis or chronic appendicitis may also be recommended for appendectomy. Ultimately, the decision to perform an appendectomy is based on the individual patient’s symptoms, medical history, and the surgeon’s assessment of the situation.

Timeline

  • Patient experiences abdominal pain, loss of appetite, nausea, and possibly fever
  • Patient visits a doctor or emergency room for evaluation
  • Doctor performs physical examination, blood tests, and possibly imaging tests to diagnose appendicitis
  • If appendicitis is suspected, patient undergoes appendectomy surgery
  • Before surgery, patient may need to fast and receive antibiotics
  • During surgery, surgeon removes the inflamed appendix
  • After surgery, patient may experience pain, soreness, and fatigue
  • Patient is monitored for complications such as infection or abscess formation
  • Patient is discharged from the hospital within a few days and instructed on post-operative care
  • Patient may need to follow up with their doctor for a check-up and to remove any stitches or staples.

What to Ask Your Doctor

Some questions a patient should ask their doctor about appendectomy may include:

  1. What are the risks and benefits of having a laparoscopic appendectomy versus an open appendectomy?
  2. How will the surgeon close the appendiceal stump during the procedure?
  3. What factors determine whether my appendicitis is considered complicated or non-complicated?
  4. Will abdominal lavage be performed during the surgery, and if so, why?
  5. How long is the recovery time expected to be, and what should I expect during the recovery process?
  6. What are the potential complications or side effects of the surgery?
  7. Are there any alternative treatment options for appendicitis that I should consider?
  8. How soon can I resume normal activities after the surgery?
  9. Will I need any follow-up appointments or tests after the surgery?
  10. What is the success rate of appendectomies performed by the surgeon or surgical team?

Reference

Authors: Obrist NM, Tschuor C, Breitenstein S, Vuille-Dit-Bille RN, Soll C. Journal: Updates Surg. 2019 Jun;71(2):375-380. doi: 10.1007/s13304-019-00654-z. Epub 2019 Apr 13. PMID: 30982171