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MARY ANTONETTE
LEONARDO
RODRIGUEZ
GROUP III- BSN III-A
\HA1 IS APPENDEt1OMY
An appendecLomy ls an emergency
surglcal procedure Lo remove an lnflamed or
lnfecLed appendlx a condlLlon known as
oppendicitis WlLhouL surgery Lhe appendlx
can rupLure spllllng lnfecLlous maLerlal lnLo
Lhe bloodsLream and abdomen whlch can be
llfeLhreaLenlng 1here ls no alLernaLlve
LreaLmenL surgery ls consldered Lhe only way
Lo LreaL appendlclLls
lt0lCATl0t F0R SuR6FRY.
An appendecLomy ls
mosL ofLen done as an
emergency operaLlon Lo
LreaL append|c|t|s
AppendlclLls ls
lnflammaLlon of Lhe
appendlx lL can be
caused by an lnfecLlon
or obsLrucLlon
C0NIRAlN0lCAIl0N F0R
I0R0RV:
1he only
conLralndlcaLlon Lo
removlng Lhe appendlx ls
a slLuaLlon where
perforaLlon has occurred
and Lhe abdomen ls so
lnflamed LhaL Lhe
appendlx ls noL
recognlzable ln Lhls
slLuaLlon Lhe lnfecLlon
needs Lo be dralned buL
Lhe appendlx ls noL
removed
I!!!!!
aparoscoplcappendecLomy
W ln mosL laparoscoplc appendecLomles surgeons
operaLe Lhrough 3 small lnclslons (each x Lo Z lnch)
whlle waLchlng an enlarged lmage of Lhe paLlenL's
lnLernal organs on a Lelevlslon monlLor ln some cases
one of Lhe small openlngs may be lengLhened Lo 2 or
3 lnches Lo compleLe Lhe procedure
W 1hls Lechnlque does Lake longer Lhan a sLandard open
appendecLomy and cosLs sllghLly more because of Lhe
lnsLrumenLs requlred for Lhe surgery
CONTRAINDICATIONS FOR
LAPAROSCOPIC
APPENDECTOMY:
emodynamlclnsLablllLy
ackofsurglcalexperLlse
ANLS1nLSIA ICk LAAkCSCCIC
ALNDLC1CM
ecause of Lhe lnherenL surglcal Lechnlque
and requlremenLs general anesLhesla ls Lhe
preferred meLhod ln performlng a
laparoscoplc appendecLomy
AdmlnlsLer preoperaLlve anLlbloLlcs Lo cover
gramnegaLlve and anaeroblc bacLerla
IQLIPMIN18 fOk IAPAkO8cOPIc
APPINDIc1OMY:
efore Lhe procedure beglns all equlpmenL musL be presenL ln Lhe surglcal arena and musL be
checked for proper worklng capaclLy
All meLhods of laparoscoplc appendecLomy requlre Lhe sLandard laparoscoplc equlpmenL
lncludlng Lhe followlng
W 1rocars
W lunL graspers
W ook elecLrocauLery
W aparoscope 30 10 mm
W LlecLrosurglcal devlce (eg elecLrocauLery wand armonlc Scalpel LLhlcon Sommervllle n!
Sonosurg Clympus amburg Cermany)
lf avallable Lhe followlng equlpmenL ls also helpful
W aparoscope 30 3 mm
W aparoscoplc cllp appller
W LndoClA 43mm whlLe carLrldge
W SucLlon lrrlgaLor
W Lndoloops
W Lndobag
YNOGNS
&Y GNSPENS
OOM EEGYNOG&YENY
PNOSGOPE
S&GYtO tNNtGYON
EOOOPS
EOGS
P0SITI0NING F0R LAPAR0SC0PIC
APPENDECT0MY
9lace Lhe paLlenL suplne and Luck Lhe lefL arm for lnlLlal
perlLoneal access
A slngle monlLor ls besL poslLloned Lo Lhe rlghL of Lhe
paLlenL along Lhe llne of Lhe rlghL anLerlor superlor
lllac splne (ASlS)
upon abdomlnal lnsufflaLlon and laparoscope
lnserLlon sLeep 1rendelenburg poslLlonlng allows
proper placemenL of Lhe lasL 2 Lrocars AfLer all of Lhe
Lrocars have been placed placlng Lhe paLlenL lefL slde
down alds gravlLy ln relocaLlng Lhe small bowel away
from Lhe appendlceal/cecal fleld of vlslon
>1CJ> JJC>CCJC
JJCDCC1C|.
'c| !. 1:| o :n|:cd |||cnd:x.
'c| 2. ^||cnd:cu|r :ccn'r, cd :n |'r|u-
:|':c orcc| d:v:dcd |'cr co|qu|':on.
'c|3. C|'qu' cx'r| cor|orc| oo|
'c| =. l|c o 'c |||cnd:x ||ccd
|round 'c |c :q|'cd
'c| 5. ^||cnd:x d:v:dc
'c| c. Lnd rcu' o.:nq :|
'u:| o |||cnd:x .
OPEN APPENDECTOMY
Cpen appendecLomy ls Lhe LradlLlonal
meLhod and Lhe sLandard LreaLmenL for
append|c|t|s 1he surgeon makes an lnclslon ln
Lhe lower rlghL abdomen pulls Lhe appendlx
Lhrough Lhe lnclslon Lles lL off aL lLs base and
removes lL Care ls Laken Lo avold spllllng
purulenL maLerlal (pus) from Lhe appendlx
whlle lL ls belng removed 1he lnclslon ls Lhen
suLured
INDICA1ICN
Lver slnce belng descrlbed by
Mcurney open appendecLomy has been a
wellesLabllshed and wldely performed
operaLlon lndlcaLed for paLlenLs wlLh acuLe
appendlclLls (AA) Cpen appendecLomy carrles
mlnlmal rlsk and has an exLremely shorL
lengLh of hosplLal sLay
CCNTRAINDICATICNS:
lack of surglcal experLlse and necessary equlpmenL
severe pulmonary dlsorders (eg CC9 lnLersLlLlal lung
dlseases)
a bleedlng dlaLhesls
severe hearL fallure
porLal hyperLenslon
lnLolerance of (le hypoLenslon due Lo) 1rendelenburg
poslLlonlng
poor vlsuallzaLlon
severe adheslve dlsease from prevlous abdomlnal
surgerles
$%$
4enera| (|s usua||y the f|rst
cho|ce espec|a||y |n ped|atr|c
pat|ents)
4keg|ona|
4Loca|
BQUIFBQH
All equlpmenL musL be presenL ln
Lhe surglcal arena and checked for
proper worklng capaclLy before Lhe
procedure beglns
AlmosL Lhe same wlLh
laparoscoplc appendecLomy
!$%
W 9lace Lhe paLlenL suplne and Luck hls or
her rlghL arm for Lhe duraLlon of Lhe
procedure
W 1he surgeon should sLand on Lhe
paLlenLs rlghL and Lhe asslsLanL surgeon
should sLand on Lhe paLlenLs lefL
STEPS IN OPEN APPENDECTOMY
_re +. [:l|~eJ ~e:J. Je|..eeJ lc ~
.g|r .|.~c lc--~ .:c.-.c:.
W _re z. [:l|~eJ ~e:J. e.:g ec.eJ
~lre |.g~rue cl ~e:J.cu|~ e-e:req.
PRE-OPERATIVE
NORSING MANAGEMENT
!. ^ d:|qno':c 'c' |nd |roccdurc |rc cx||:ncd 'o |ro:o'c co:or'
|nd rc|x|':on.
2. !|:n'|:n |n l... :nc 'o ::|rovc u:d |nd ccc'ro,'c ||ncc |nd
nu'r:':on| '|'u.
3. ^c ||':cn' or |rccncc o |crq:c uc | |cn:c::n |crq,.
=. ^n :nor:cd concn' : '|cn ro: 'c ||':cn' o '|' 'c,
undcr'|nd 'c |roccdurc |nd ccr'|:n :cd:c|':on '|' 'c, .oud c
rccc:v:nq.
5. ln'ruc' ||':cn' no' 'o c|' or dr:n |'cr ::dn:q' on 'c d|, corc
urqcr, or | rou':nc ||nncd ccduc.
c. ^n'::o':c |rc ordcrcd 'o dccrc|c 'c |c'cr:| qro.' :n 'c coon.
?. lo.c cc|n:nq .: c :n:':|'cd ! 'o 2 d|, corc urqcr, or c''cr
v:u|:z|':on.
C0MLfCTf0KI
W Jound |nfect|on
W Abdom|na| abscess due to sp|||age of bacter|a
after a ruptured append|c|t|s
W 8owe| obstruct|on
W Ur|nary tract |nfect|on
W nemorrhage
W In[ury to the |arge or sma|| bowe| ovary or
other abdom|na| organs requ|r|ng remova|
)C;TC) AU1;JA
!AAA!!!AT
W unrupLured appendlx
1he paLlenL ls sLarLed on a llquld dleL Lhe mornlng afLer Lhe surgery and progressed Lo a sofL and
Lhen regular dleL
AddlLlonal anLlbloLlcs are also glven Lo prevenL wound lnfecLlon
CfLen Lhe paLlenL can leave Lhe hosplLal ln 12 days afLer Lhe surgery
W 8upLured appendlx
1he hosplLal sLay ls usually aL leasL 4 days and posslbly longer
lf Lhere was spllllng of bacLerla from Lhe appendlx recurrenL abdomlnal abscesses and lnfecLlons
may occur
1he bowel frequenLly sLops normal funcLlon (lleus) causlng bowel fluld and gas Lo dlsLend Lhe bowel
1hls dlsLenLlon ls relleved by placlng a Lube Lhrough Lhe nose and lnLo Lhe sLomach for approxlmaLely
23 days Cnce Lhere ls evldence LhaL Lhe lnLesLlnes are acLlve agaln such as passlng gas or havlng a
bowel movemenL Lhe Lube ls removed
1he paLlenL ls Lhen be sLarLed on a llquld dleL whlch ls advanced Lo a regular dleL as LoleraLed
lf Lhe appendlx has rupLured a draln ls placed ln Lhe reglon of Lhe appendlx Lo allow bacLerla Lo draln
ouL and Lhe skln ls lefL open and packed wlLh gauze 1he gauze and draln are removed when Lhe
lnfecLlon ls cleared
AnLlbloLlcs are conLlnued for approxlmaLely one week afLer Lhe surgery lnlLlally Lhls wlll be Lhrough a
veln whlle ln Lhe hosplLal and Lhen Lyplcally by plll afLer belng senL home
THANK
YOU!!!!!!