Appendicitis Treatment: Appendectomy (Open vs. Laparoscopic) and Perioperative Care
Acute appendicitis is a surgical emergency. Appendectomy (appendix removal) is definitive treatment; antibiotics alone are reserved for select uncomplicated cases or as bridge.
Surgical Approaches
| Aspect | Open Appendectomy | Laparoscopic Appendectomy |
|---|
| Incision | McBurney (RLQ oblique, 5–10 cm) | 3 ports (umbilical camera, 2 working) |
| Visualization | Direct | Magnified video |
| Advantages | No specialized equipment; faster in obese/severe inflammation | Less pain, shorter stay, faster recovery, better cosmesis, lower SSI |
| Conversion | N/A | 10–20% (perforation, adhesions, obesity) |
Perioperative Care
Pre-operative
- IV fluids (resuscitate if dehydrated/septic)
- Broad-spectrum antibiotics (cefotetan, piperacillin-tazobactam, or ceftriaxone + metronidazole) before incision
- Analgesia (multimodal: acetaminophen, NSAID, opioid PRN)
Post-operative
- Monitor vitals, wound, urine output
- Pain control: scheduled acetaminophen + NSAID; opioid for breakthrough
- Diet: advance from clears to regular as tolerated (often same day)
- Ambulate early (within 6–12 hrs)
- Antibiotics: 24 hrs for uncomplicated; 4–7 days for perforated/abscess
- Follow-up: 1–2 weeks; suture/staple removal if non-absorbable
Special Scenarios
- Appendiceal mass/abscess: Initial antibiotics ± percutaneous drainage → interval appendectomy 6–8 weeks later.
- Pregnancy: Laparoscopic preferred; fetal monitoring; antibiotics cover anaerobes.
- Pediatrics: Laparoscopic standard; similar principles.
Laparoscopic appendectomy is preferred for most patients. Surgeon expertise and intraoperative findings dictate final approach.
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