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Indications to appendectomy at an appendicism - appendectomy Complications

Table of contents
Appendectomy complications
Reasons of postoperative complications 2
Reasons of postoperative complications 3
Reasons of postoperative complications 4
Indications to appendectomy
Indications to appendectomy - appendicular infiltrate
Indications to appendectomy at not changed shoot
Indications to appendectomy at an appendicism
Indications to appendectomy - postoperative supervision
Complications from a wound
Complications from a wound, the choice of methods of treatment
Complications from a wound - the general treatment
Complications from a wound - eventration
Complications from a wound - use of antibiotics for prevention of early complications
Early complications from an abdominal cavity
Peritonitis
Diffuse peritonitis
Diffuse peritonitis - a peritoneal dialysis
Diffuse peritonitis - an intestines peristaltics
Infiltrates and abscesses of an abdominal cavity
Abscesses of an abdominal cavity
Abscesses interloopy and right ileal area
Subphrenic abscesses
Phlegmons of retroperitoneal cellulose
Acute intestinal impassability
Acute postoperative pancreatitis
Complications from cardiovascular system
Thromboembolism of a pulmonary artery
Myocardial infarction, pylephlebitis
Fibrinferments and embolisms of mesenteric vessels
Prevention of tromboembolic episodes
Complications from a respiratory organs
Complications from an urinary system
Late complications from an abdominal wall
Recognition of inflammatory "tumors" of a front abdominal wall
Origins of postoperative hernias
Late complications from an abdominal wall - keloid cicatrixes
Late complications from abdominal organs
Infiltrates and abscesses of an abdominal cavity
Inflammatory "tumors" of an abdominal cavity
Intestinal fistulas
Adhesive desease
The recommended literature

Appendectomies at an appendicism, from the point of view of the operating surgeons, at most of patients are justified. Unfortunately, many remote shoots are not exposed to histologic research that does not grant the right to judge expediency of such operation. Sometimes even data of histologic research not always authentically confirm a chronic inflammation. Possibly, it is possible to receive the affirmative answer, subjecting to histologic research worm-shaped shoots of persons which had no complaints and any clinical signs of an appendicism. Being engaged in an esophagoplasty from a large intestine and in some cases using for creation of an artificial gullet its right half with ileocecal department, we, moving this department to a chest cavity and on a neck, previously carried out appendectomy. All patients of the complaints indicating an inflammation of a worm-shaped shoot operated with us did not show and they had no symptoms of this disease. After removal of a worm-shaped shoot at 8 patients we, without indication of circumstances of withdrawal, transferred them to patogistologichesky laboratory where changes which allowed to establish the pathomorphologic diagnosis — "an appendicism aggravation" were found.
All this testifies to relativity of the diagnosis of an appendicism in most cases. At the same time it must be kept in mind that quite often after the appendectomy which is carried out without the sufficient bases there are same phenomena, as before operation, but also, there can be a number of the complications in the late postoperative period connected directly with intervention (an adhesive desease, kultita, hem neurinoma Etc.).
We do not stand on those positions that it is necessary to refuse operational treatment of an appendicism. Such diagnosis exists and operational treatment should be carried out, but it is necessary to limit strictly indications to it. As reliable it is necessary to consider the diagnosis if in the past the patient had attacks of an acute appendicitis and now the residual phenomena remain. Especially operation is absolutely shown in cases when in former time the patient had appendicular infiltrate. Danger of repetition dictates it need of operational treatment. The diagnosis is justified if it is established on set of anamnestic, objective and radiological signs and at the same time other diseases of abdominal organs or nearby bodies of retroperitoneal space are rejected (urinary tract etc.).
The volume of preoperative preparation at an acute appendicitis is minimum. No actions, except a hygienic bathtub (and that only at uncomplicated forms), are undertaken. In anticipation of operation patients have to refuse meal.
The preparation for surgery of patients with an appendicism can be a little expanded. First of all it is necessary to remember that operation in these cases can be executed only in the absence of contraindications to it. Existence of the diseases to some extent complicating a current of the postoperative period forces to refuse operational treatment. In these cases appendectomy should be made at height of an attack or after relative elimination of an associated disease.
Operations at persons with diseases of cardiovascular system, diabetes need to be made only on condition of their full compensation and the corresponding training of the patient.
In the course of preoperative research of patients it is necessary to attach significance to catarrhal diseases, pustulous damages of skin, especially in the field of a surgery field. All this postpones the operative measure time.
When performing operation in a planned order the surgeon has an opportunity to take care of the corresponding preparation of a digestive tract. For this purpose in 2 — 3 days prior to operation of the patient transfer to a sparing diet, and on the eve of operation appoint a cleansing enema. It is important action in anticipation of inevitable paresis of intestines in the first postoperative days. Direct preparation in day of operation is reduced to care of a condition of a surgery field and premedication in the form of introduction of Promedolum and atropine for potentiation of local anesthesia.
In modern surgery at an acute appendicitis the majority of operations carry out under local anesthesia. Obviously, local anesthesia at simple, uncomplicated forms of appendicitis is quite acceptable. At the same time means that the surgeon perfectly knows technology of local anesthesia. In anticipation of difficulties of the forthcoming intervention at persons where it will be complicated owing to constitutional features or weight of pathological process, it is necessary to choose a type of the general anesthesia in advance. We consider the general anesthesia expedient and at symptoms of diffuse peritonitis or an ambiguity of the diagnosis when the source of diffuse peritonitis is unknown. The similar point of view expresses also other surgeons (V. S. Savelyev et al., 1971; M. M. Kovalyov et al., 1972).
Known and eurysynusic formula: to each patient the method of anesthesia — perhaps, it is most characteristic of the appendectomy which is carried out quickly. The surgeon himself chooses the most acceptable anesthesia in these specific conditions. It is important only that all these questions were thought timely over before operation. The most unsuccessful option is transition to the general anesthesia during operation at its technical difficulties or owing to inadequate reaction of the patient. Also change of a type of the general anesthesia in the course of carrying out an operative measure is unsuccessful (transition from a mask anesthesia to an intubation). Thinking over the plan of the forthcoming operation, the surgeon has to consider and to leave everything for himself a possibility of a wide field of action in not clear cases. Therefore in similar situations we prefer to use the general anesthesia in the form of an endotracheal anesthesia with muscular relaxants.



 
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