Chapter 20. Appendectomy

• Clinical suspicion of appendicitis in an ill-appearing patient.

Absolute

• None.

Relative

• Presence of large periappendiceal abscess, which may be treated best with initial drainage and interval appendectomy.
• Suspicion of Crohn's disease involving the cecum at the base of the appendix.

Open Appendectomy

• The patient should be supine with both arms extended.
• The entire abdomen is prepared and draped in case a midline incision is needed (eg, unexpected disease is encountered or the operative course dictates it).

Laparoscopic Appendectomy

• The patient is supine with both arms tucked at the sides. The operating surgeon and assistant stand on the patient's left.
• A Foley catheter is placed to decompress the bladder.
• The patient's entire abdomen is prepared and draped.

• Patients should be advanced to a regular diet as tolerated and discharged home when they can tolerate oral intake and manage pain with oral medication only.

• Injury to bowel or other adjacent structures.
• Intra-abdominal abscess.
• Superficial wound infection (more common with open appendectomy).
• Colonic fistula.