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  • Postoperative Care, Complications, and Prevention of Stump Appendicitis Following Appendectomy

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    Naily Hosen
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    This document discusses postoperative care and complications following appendectomy. It notes that uncomplicated appendectomies have low complication rates and patients can be discharged quickly, while complicated cases require longer antibiotic treatment and have higher risks of infections. It describes surgical site infections, particularly at extraction ports for laparoscopic procedures, and treatments for intra-abdominal abscesses. It also discusses incomplete removal of the appendix (stump appendicitis), which typically presents with recurrent appendicitis about 9 years later, and emphasizes using the appendiceal critical view technique to fully remove the appendix and prevent stump appendicitis.

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    komplikasi apendiktomi

    Titolo originale

    Komplikasi Post Apendiktomi

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    This document discusses postoperative care and complications following appendectomy. It notes that uncomplicated appendectomies have low complication rates and patients can be discharged quickly, while complicated cases require longer antibiotic treatment and have higher risks of infections. It describes surgical site infections, particularly at extraction ports for laparoscopic procedures, and treatments for intra-abdominal abscesses. It also discusses incomplete removal of the appendix (stump appendicitis), which typically presents with recurrent appendicitis about 9 years later, and emphasizes using the appendiceal critical view technique to fully remove the appendix and prevent stump appendicitis.

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    © All Rights Reserved
    Scarica in formato DOCX, PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    211 visualizzazioni2 pagine

    Postoperative Care, Complications, and Prevention of Stump Appendicitis Following Appendectomy

    Caricato da

    Naily Hosen
    This document discusses postoperative care and complications following appendectomy. It notes that uncomplicated appendectomies have low complication rates and patients can be discharged quickly, while complicated cases require longer antibiotic treatment and have higher risks of infections. It describes surgical site infections, particularly at extraction ports for laparoscopic procedures, and treatments for intra-abdominal abscesses. It also discusses incomplete removal of the appendix (stump appendicitis), which typically presents with recurrent appendicitis about 9 years later, and emphasizes using the appendiceal critical view technique to fully remove the appendix and prevent stump appendicitis.

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    © All Rights Reserved
    Scarica in formato DOCX, PDF, TXT o leggi online su Scribd
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    di 2

    POSTOPERATIVECAREANDCOMPLICATIONS

    Followinguncomplicatedappendectomy,complicationratesarelowandmostpatients
    canquicklybestartedonadietanddischargedhomethesamedayorthefollowingday.
    Postoperative antibiotic therapy is unnecessary. Alternatively, with complicated
    appendectomy,complicationratesareincreasedcomparedtouncomplicatedappendicitis.
    Patientsshouldbecontinuedonbroadspectrumantibioticsfor4to7days.Postoperative
    ileus may occur, so diet should be started based on daily clinical evaluation. These
    patientsareatincreasedriskforsurgicalsiteinfections.
    SurgicalSiteInfection
    Inpatientswithincisional(superficialordeep)surgicalsiteinfection,treatmentshouldbe
    openingoftheincisionandobtainingaculture.Followinglaparoscopicappendectomy,
    theextractionportsiteisthemostcommonsiteofsurgicalsiteinfection.Patientswith
    cellulitiscanbestartedonantibiotics.Theculturedorganismsaretypicallybowelflora,
    asopposedtoskinflora.
    Patientswithpostoperativeintraabdominalabscessescanpresentinavarietyofways.
    Althoughfever,leukocytosis,andabdominalpainarecommonpresentations,patients
    withileus,bowelobstruction,diarrhea,andtenesmusmayalsoharborintraabdominal
    abscesses. Small abscesses can be simply treated with antibiotics; however, larger
    abscesses require drainage. Most commonly, percutaneous drainage with CT or
    ultrasoundguidanceiseffective.Forabscessesnotamenabletopercutaneousdrainage,
    laparoscopicabscessdrainageisaviableoption.
    StumpAppendicitis
    Incompleteappendectomyrepresentsafailureofremovingtheentireappendixonthe
    initialprocedure.Areviewofliteraturehasrevealedonly60reportsofthisphenomenon.
    Likely, incomplete appendectomy is underreported, and the true prevalence is much
    higher. Reported as stump appendicitis, patients typically present with recurrent
    symptomsofappendicitisapproximately9yearsaftertheirinitialsurgery.Therewasno
    differenceininitialsurgerybetweenlaparoscopicandopenprocedures.However,there
    weremorecomplicatedappendectomiesoninitialsurgery.Patientspresentingwithstump
    appendicitisaremorelikelytohavecomplicatedappendicitis,haveanopenprocedure,
    andundergocolectomy.
    Thekeytoavoidingstumpappendicitisisprevention.Useoftheappendicealcritical
    view(appendixplacedat10oclock,taeniacoli/liberaat3oclock,andterminalileum
    at 6 oclock) and identification of where the taeniae coli merge and disappear is
    paramount to identifying and ligating the base of the appendix during the initial
    operation.Theremainingstumpshouldbenolongerthan0.5cm,asstumpappendicitis
    hasonlybeennotedinstumpscmintheliterature.
    Inpatientswhohavehadpriorappendectomy,alowindexofsuspicionisimportantto
    prevent delay in diagnosis and complications. Prior appendectomy should not be an
    absolutecriterioninrulingoutacuteappendicitis.

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