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MODIFIED APPENDICECTOMY - Page 2

Article Index
MODIFIED APPENDICECTOMY
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DISCUSSION

 

All the methods dealing with appendiceal stump has advantages' and disadvantages. It has been proved pragmatically that the invagination of the ligated stump and only ligation of the stump has no difference in post operative complications (8, 13). The invagination of stump may compromise blood supply of the caecum and can cause inflammation and may promote the adhesions. The interupted sutures creat,e no problem about vascularity of Lhe caecum and it is also guarded by second sero muscular layer. Persistence of small appendieeal stump may be nesponsible for post appendicectomy pain and perforation of the long stump has been reported by Francis 1979 (17). The complete removal of the appendiceal tissue is only possible along vlith core of the caecal wall. In general the understanding about poor healing of the caecal wounds due to less vascularity is changed and confirmed by caecoplasties. Only 1\o/o cases had wound infection (Table 4) similar incidence holds good for the routine appendicectomies with or without invagination of the stump (8,9,12). The modif ied procedure has no added complications like increase in the incidences of wound infection, faecal fistula or intraperitoneal abscess. All the way it has proved complete removal of the appendiceal tissue, doubly secured haemorrhage from the caecal wall, absolute reduction in raw surf ace, no compromisation of theblood supply of the caecal wall and no deformity of caecum The average operation time required is 46 minutes is also same as routine procedures require (12). Though it is small series of 150 cases in this .n"tyrir, it is encouraging to advocate a better appendicectomy truly needed for the disease appendicitis.

REFERENCES

1. Berry J. Malt R.A. Appendicitis near its centenary Ann. Surgery 1984 Z0O 569 _ 5J5.

2' Edwards F.H. Davies R.s. use of a bayesian algorithm in the computer assisted diagnosis of appendicitis. 4

3' Gottrup F' Prophylactic metronidazole in prevention of infection  after the appendicectomy. Repor[ of a double blind trial, Acta chir scand. 146_133.1980.

4' Loffal Ld, cooperman A. Etal, Appendicitis : A continuing surgical challenge An. J. Surg. 11j-654_1961.

5' Oschner A. Lilly G.; The technique of appenflicectomy - Surgery 19Jl l;5)2-53.

6' Bradley EL III and ,lsaac J' Appendiceal abscess revisited Arch surg.113-1tA-82 1g78.

7. Sinha Ap. : Appendieectomy an assessmdnt of the advisibility of stump, invagination, Br. J. Surg. G4 z 449-?00- 1977.

B' Thomas M. P, Burst stump abscess f ollowing appendieectomy. A report of our cases N,Z" Surg. 441 4l-49 z 1974.

9' Lassalle AJ, Andrassy RJ : Page Cp, etal. Intussusception of appendiceal stump, elin. pediatri , 19 : 4jz_4j5_1980.

10' Sandmark M. Serious delayed rectal haemorrohage following haeomplinatecl appendieectomy. Report of a case, Acta. Chir Scand 143 : l,l5-18(t ^,gll.

11' 'Kronlen RU. Ueber die operalive Behandlund der aeulen difusen Jauchigeiteri-gen peritcultis. Arehis Klin chir. lBBg z 33 z 507 - ?4,

12. L. Engstron, G. Fenyo, Appendicectomy assessment of stumP invagination '-versus simPle ligation. Br. J. Surg. 1985 z 7?. 971-97''

13. 1t. Kingsley DEP, some observation on appendicectomy with particular reference to technique' Br' J' Surg' 1969 z 491-496'

14. A. Murray and MR. Madigan' The leukocyte count and histological appearance in acute appendicitis - Br' J' Surg' Vol 171-119-'20 - 1984'

15. BatesT;DownRHLetal,Topicalampicitlinsinthepreventionsofwound infection after appendicectomy Br' J' Surg' 61 z 489' 1974'

16. Tanphiphatic; Sangsuubhanc; vanqvarvipartv etal a lvound infection in emergency appendieectomy a prospective trial with topical ampicillin and antiseptic solution irrigation' Br'J'surg' 1978 t 65'

17. Fransis D. The grumbling appendix Br' Med' J' 21 936-1979'