continue from part one of this article. If you have not read it please click here
The best possible way of treatment of appendicitis will be advised by the surgeon.
If a surgeon saying that you need surgery means what? whether to rely on his opinion or not.
I could not fully disagree with you, the common people of India, which say that doctor always think of their business and make such patient to operate and admit in hospital.
But such doctors are very few and more than 90% of doctors are good which will not misguide you. I can say please go with your consultant surgeon opinion.
Now you still confused about whether to operate or whether to go with medicines only.
Medicine or surgery
Before that, I must take advantage to suggest to you that there is only one type of treatment for every infection or every disease. Here I wanted to emphasize that if any pathology needs surgery means that is the only treatment available. It could not be that the medicine will do the job of surgery.
And if any disease could be treatable with medicine means that is only that is the way to treat it and not surgery.
So believe me, if appendix infection is there and the patient has vomiting, the patient has a fever, and there is severe tenderness in the abdomen, I could not believe in the medicine line of treatment. Just to avoid the surgery, I could not take the risk of the perforation of the appendix.
I could not take the risk of loss of the Year of the student if a patient is a school going child or college going student.
Because even if you manage it with the medicine over the duration of one week, you can not guarantee in the future that it will not re-appear again.
In future whenever there could be exam days, it can reappear and that may result in a loss of a whole year because of failure in the exam.
This example applied to all the situation for any person. You can best think that this infection can reappear in any situation, any time, where you could be in more loss than going with the surgery this time.
But could you explain what are the conditions, we can manage with medicine.?
So that we can get some time to decide whether to operate or not. Or could you tell us what is the condition where we should blindly agree to the decision of the surgeon for surgery?
Yes, of course, I can give you some suggestion regarding this disease whether to go with surgery or not.
Suppose the patient has pain, vomiting and fever on yesterday. Today he has undergone an investigation suggesting appendicitis on ultrasonography. But there is no any surrounding Pathology in the right iliac fossa. And clinically there is no guarding and rigidity.
In such conditions, to get you some time to collect money for surgery or to become prepare mentally or any other reason, you can try medicine for 5 days which can resolve appendix infection and later in second painful attack, you can go for the surgery.
Here the main important point you have to note that the pain is not severe, and the abdomen is not so tender.
Hence in such a situation, where we can say infection is resolving, you can try medicines, which means a conservative line of treatment.
Now come to the next situation.
The look of the patient is toxic, he could not even rise from the bed, Patient has severe pain in the abdomen, it increases in walking, even when the doctor examines the patient.
CT scan or sonography gives a diagnosis of acute inflammatory appendicitis with some fluid collection in the right iliac fossa.
These all points are suggesting a severe type of appendix inflammation, which if left untreated, may perforate inside the abdominal cavity. And that can lead to fatal appendicular perforation peritonitis or appendicular abscess formation.
Hence in this situation, you must go with the surgery without thinking of any other opinion or any other miss- guidance.
So, these are the two situations, which I have explained to you. There is no alternative to any treatment if the requirement is a medicine you can go with but if the requirement is surgery, you must have to go with it.
ok ok,
I have understood what to do and what not to do whenever there is an appendix infection.
But now again one question, whether to go with
open surgery or laparoscopic surgery.
It is a very good question. You all must know about these modalities for a better outcome for your patient. But laparoscopy surgery is a costly procedure than an open type of operation.
If an open type operation has expenditure of around 40,000 rupees, in mid-level hospitals, means average good Hospital, then the laparoscopy surgery cost will be about 60 thousand rupees. so there is a cost difference between these two surgeries.
First where you cannot do laparoscopy surgery.
# In case of appendicular perforation where the whole of the abdomen is filled with pus collection.
# In appendicular abscess formation.
# In old age patient, where there is respiratory problem and patient can not go under general anaesthesia.
# In patient, where multiple times some abdominal surgeries have performed in past.
# In case of recurrent appendix infection, which is very rare nowadays.
In all such situation, you cannot go for laparoscopy. so do not pressurise the surgeon for laparoscopy.
What is the situation where we can go for laparoscopy
# When the patient is young.
# When a patient is a student when appendix pain history is around 5 days,
# When it is diagnosed as tubular appendix structure in CT scan and there are no any other associated pathology or no any collection around the appendix.
# When there are two pathologies like the appendix and right ovarian cyst or left ovarian cyst. In such condition, we can go with laparoscopy to tackle both these diseases.
# In very obese patient, > 100kg, where open surgery could be devastating and time-consuming, due to a very thick layer of fat. Which could land the patient in wound infection later on.
In such conditions, one can opt for laparoscopic surgery.
Ok
Now we understood the type of surgeries. Whether to go for open or laparoscopy surgery and what is the common situation in case of acute appendicitis.
The last question remains what are the chances of recurrence after appendix surgery.
In another word, what is a guarantee that we will be not suffered in future from Acute appendicitis?
In the medical field, we cannot use the word “guarantee” But yes, we can say, after successful appendix surgery, there could not be appendix infection again. Because we are excising all appendix from its base, hence there are very few chances of appendix infection. As the appendix has been removed and there will be no such structure as the appendix.
But in some cases when appendix base is not visualised during surgery and some part of the appendix has been left after surgery. In such a situation, the remaining portion of the appendix could get the infection again. In fact, the patient may suffer from appendicitis in future. That could be called as recurrent appendix infection or stump appendicitis but such possibilities are very rare.
you can say this is very rare to get stump appendicitis. so you will not get the disease again in your lifetime. Hence go for it, do surgery and get relieved for a lifetime.
This is all about the appendix and its infection. If you have any doubt regarding the topic or you want to ask me any question, you are welcome here always.
Thanks.
If you have not read part one, please click here
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