Our Summary

This paper discusses the treatment of acute appendicitis (AA), a condition where the appendix becomes inflamed and needs to be removed quickly. The diagnosis can be made through blood tests and detailed CT scans. The best way to treat AA is through an emergency procedure called laparoscopic appendectomy (LA), where the appendix is removed using small instruments inserted through tiny cuts in the abdomen.

The researchers suggest that waiting 6-12 weeks to do the surgery is risky, as the inflammation could come back during this time. However, they recognize that this delay could be beneficial in some cases where the patient has a mass in the appendix.

Surgery is not recommended for children with AA - instead, it’s usually managed through other means. The risk of complications after surgery increases based on the patient’s individual factors. For high-risk patients, it may be best to wait a bit before putting them under general anesthesia for the procedure.

The surgeons’ skills and the hospital’s resources are important for the success of the LA. A delay of less than 24 hours from diagnosis to surgery is considered safe. In some cases, doing the LA within 24 hours after symptoms start could be acceptable, depending on the patient’s condition and available resources.

The paper also mentions that the universal health insurance system in Japan covers the cost of this surgery.

FAQs

  1. What is the first therapeutic choice for acute appendicitis?
  2. Is it safe to delay appendectomy for 6-12 weeks after disease onset?
  3. What factors increase the risk of postoperative complications after a laparoscopic appendectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laparoscopic appendectomy is to follow post-operative instructions carefully, including taking prescribed pain medication, avoiding strenuous activities, and keeping the incision site clean and dry to prevent infection. It is also important to follow up with your surgeon for any concerns or complications that may arise during the recovery process.

Suitable For

Patients who are typically recommended for laparoscopic appendectomy include those with acute appendicitis, as well as those who have a white blood cell count and enhanced computed tomography findings supporting the diagnosis. Emergent laparoscopic appendectomy is considered the first therapeutic choice for acute appendicitis, as delaying surgery can lead to a higher risk of complications and recurrence. Non-operative management may be considered in children, but prompt surgery is recommended for most patients. Patients who are at high risk for postoperative complications may benefit from a delay in surgery, but prompt surgery within 24 hours of diagnosis is generally safe. Overall, successful laparoscopic appendectomy requires skilled surgeons and cooperation from the hospital.

Timeline

  • Before Laparoscopic Appendectomy:
  1. Patient experiences symptoms of acute appendicitis such as abdominal pain, nausea, vomiting, and fever.
  2. Patient seeks medical attention and undergoes physical examination, blood tests, and imaging studies such as enhanced computed tomography for diagnosis.
  3. Diagnosis of acute appendicitis is confirmed based on findings of white blood cell count and imaging studies.
  4. Emergent laparoscopic appendectomy is recommended as the first therapeutic choice for acute appendicitis.
  • After Laparoscopic Appendectomy:
  1. Patient undergoes laparoscopic appendectomy procedure, which is considered safe and effective for treating acute appendicitis.
  2. Postoperative complications may occur depending on the patient’s factors, but generally, laparoscopic appendectomy has a lower risk of complications compared to open surgery.
  3. Surgeon’s skill and cooperation of the hospital are important for a successful laparoscopic appendectomy.
  4. Delaying appendectomy for less than 24 hours from diagnosis is safe, but prompt laparoscopic appendectomy is considered mandatory for acute appendicitis.
  5. In some cases, a semi-elective laparoscopic appendectomy within 24 hours after onset of symptoms may be acceptable, depending on the patient, physician, and institution factors.
  6. The Japanese government’s universal health insurance system covers laparoscopic appendectomy, ensuring access to this surgical procedure for patients with acute appendicitis.

What to Ask Your Doctor

  1. What are the risks and benefits of laparoscopic appendectomy compared to open surgery?
  2. How long is the recovery time after laparoscopic appendectomy?
  3. Will I need to stay in the hospital overnight after the procedure?
  4. What kind of pain management will be provided after the surgery?
  5. Are there any dietary restrictions I should follow after the surgery?
  6. How soon can I resume normal activities, such as work or exercise, after the surgery?
  7. What signs or symptoms should I watch for that may indicate complications after the surgery?
  8. Will I need any follow-up appointments after the surgery?
  9. Are there any long-term effects or risks associated with laparoscopic appendectomy?
  10. How experienced is the surgeon in performing laparoscopic appendectomies?

Reference

Authors: Hori T, Machimoto T, Kadokawa Y, Hata T, Ito T, Kato S, Yasukawa D, Aisu Y, Kimura Y, Sasaki M, Takamatsu Y, Kitano T, Hisamori S, Yoshimura T. Journal: World J Gastroenterol. 2017 Aug 28;23(32):5849-5859. doi: 10.3748/wjg.v23.i32.5849. PMID: 28932077