Surgery

Appendectomy is the standard of care for acute appendicitis. To prevent complications arising from undiagnosed appendicitis, surgeons accept a 15 to 20 percent negative appendectomy rate. There is some debate regarding an open technique versus a laparoscopic approach in current surgical thought. The postoperative course, morbidity rates, and decreased cost favor the open approach in most cases, with laparoscopic surgery reserved for selected populations. 39 In the emergency department, patients who are being taken to appendectomy should at a minimum be given nothing by mouth, have a peripheral saline IV placed, and be given preoperative antibiotics. Analgesia need not be withheld once the decision for surgery is made. Postoperative care for uncomplicated appendicitis is minimal, with most patients going home 3 days after surgery. In cases of ruptured appendicitis, postoperative care can be complex, requiring multiple interventions to resolve sepsis, paralytic ileus, and abscess formation.

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