Appendix

It is present only in some mammals (in particular, in rabbits , monkeys , humans ) ^[2] .

Cats and dogs have no appendix ^[3] .

Diagnosing appendix problems in pets (such as rabbits and guinea pigs) is extremely difficult. ^[3]

Man

It is located in the right iliac region (below the liver) and usually descends to the entrance to the small pelvis.

Sometimes it is located behind the cecum and, rising to the top, can reach the liver.

Thickness - 0.5 - 1 cm, length - from 0.5 to 23 cm ^[4] (usually 7 - 9 cm).

It has a narrow cavity that opens into the cecum with an opening surrounded by a small fold of the mucous membrane - the flap.

The lumen of the appendix with age can partially or completely overgrow.

The appendix has a protective function, the accumulation of lymphoid tissue in it is part of the peripheral parts of the immune system. In herbivores , the microflora living in it is involved in the digestion of plant cellulose , in many cases the appendix in animals is relatively large.

It is more difficult for people with a remote appendix to restore the intestinal microflora after it has been infected ^[5] .

The appendix serves as a repository and reproduction site for bacteria necessary for the normal functioning of the intestine. The contents of the intestine usually do not enter it, due to which the organ can be a kind of “farm”, where beneficial microorganisms propagate. He had a particularly important role in ancient times, when after serious intestinal infections he helped restore the intestinal microflora. Nowadays, people can compensate for the affected microflora with the help of pharmacy drugs that normalize the intestinal microflora ^[1]. Also, as some researchers (Bill Parker et al.) Believe, due to a significant increase in population density, a modern person can also receive bacteria from other people. ^[6]

The appendix plays a saving role for the preservation of microflora, it is an incubator of E. coli. It is here that the original microflora of the colon is preserved. Appendix is ​​an organ that performs the same function for the intestines as tonsils for the lungs. It contains conglomerates of lymphoid follicles and functions as part of a single functional system of mucosal immunity.

Appendectomy - removal of the appendix (appendix). Indications: acute, chronic appendicitis. Anesthesia: Diprivan anesthesia, NLA or the like.

Most often they use access according to Volkovich-Dyakonov.

The incision line goes through the point of Mc Burney, located on the border between the outer and middle third of the line connecting the navel to the anterior superior awn of the right ilium. The section is perpendicular to this line, with 1/3 of the section length being above the line, 2/3 below the line. The length of the incision should provide a good overview of the surgical field and fluctuates, depending on the thickness of the subcutaneous fatty tissue of the patient, from 6 to 8 cm.

The subcutaneous fatty tissue is dissected with a scalpel, with a significant amount, or is removed in a blunt manner using a tupfer (or the opposite end of the scalpel) with a small amount. The superficial fascia of the abdomen is incised, and behind it the fibers of the aponeurosis of the external oblique muscle of the abdomen become visible, which are cut along with the help of Cooper scissors, thereby opening access to the muscle layer. The fibers of the internal oblique and transverse muscles are moved apart with the help of closed clamp jaws. The preperitoneal tissue is pushed back in a blunt manner, then the parietal peritoneum is picked up by two clamps and dissected.

Two options for appendectomy are possible: antegrade appendectomy and retrograde.

With antegrade appendectomy, the clamp is applied to the mesentery at the apex of the appendix. At the base of the appendix, the mesentery is pierced with a clamp. Through the hole formed, the mesentery of the process is squeezed with a clamp of the Kocher type and tied with a nylon thread, then intersected. With a swollen or abundant mesentery, it should be bandaged and crossed with the application of several clamps.

Then, at the base of the appendix, a clamp is applied and released. In this case, a groove is formed on the wall of the vermiform appendix. A catgut ligature is applied in the area of ​​this groove.

The next step is to apply a purse string suture. A purse-string serous-muscular suture is applied at a distance of about 1 cm from the base of the appendix. A clamp is applied over the catgut ligature and the process is cut off. The stump of the appendix with the help of the clamp is immersed in the cecum, a purse string suture is tightened around the clamp, after which the clamp is removed from the submerged cecum.

A serous-muscular Z-shaped suture is applied over the purse string suture.

Retrograde appendectomy is performed when there is difficulty in removing the vermiform appendix to the wound, for example, during the adhesion process in the abdominal cavity, retrocecal, retroperitoneal location of the appendix. In this case, a catgut ligature is first applied at the base of the process through an opening in the mesentery. The process is cut off under the clamp, its stump is immersed in the cecum and purse string and Z-shaped sutures are applied, as described above. And only after that they begin to gradual ligation of the mesentery of the appendix.

After an appendectomy is performed, the abdominal cavity is drained using tuffers or an electric suction pump. In most cases, the postoperative wound is sutured tightly without drainage. Abdominal drainage is performed in the following cases:

• with peritonitis
• if there is no certainty that the shoot is completely removed
• with uncertainty in hemostasis
• in the presence of periappendicular infiltrate or with the spread of inflammation to the retroperitoneal tissue
• with uncertainty about the reliability of immersion of the stump of the appendix

Drainage is carried out through a separate incision (more precisely, a puncture) using a standard tube with several holes at the end. In case of peritonitis, two drainages are established: in the area of ​​the distant process and the small pelvis, the second - along the right lateral canal. In other cases, one drainage is installed in the area of ​​the remote process and in the small pelvis.

Currently, laparoscopic appendectomy is becoming more common - removal of the appendix through small punctures of the abdominal wall with the help of special tools. In most such operations, the number of punctures reaches three. The first puncture is carried out in one centimeter above the navel, the second in four centimeters under the navel, the location of the third puncture directly depends on the location of the appendix. The advantage of laparoscopy is a reduced risk of wound infection , a shorter hospital stay, a reduced number of visits to the doctor after surgery, and a quick recovery of the patient.

In recent years, minimally invasive surgical interventions , which include transluminal surgery (endosurgical interventions, where flexible instruments are inserted into the lumen of a hollow organ through natural openings of the human body and through an incision in the wall of an internal organ, are brought directly to operated object)

With transluminal appendectomy, two accesses can be selected:

1. transgastric appendectomy (instruments are inserted through a tiny hole in the wall of the stomach);
2. transvaginal appendectomy (instruments are inserted through a small incision into the vagina).

The advantage of such operations:

1. complete absence of cosmetic defects;
2. relatively quick recovery, shortening the time of postoperative rehabilitation.

In Russia, the first successful operation to remove the appendix was performed by A. A. Troyanov (1890). At the IX Congress of Russian Surgeons (1909), the question of the need to operate on the first day was resolved. In widespread practice, early surgery has dramatically reduced the number of deaths in acute appendicitis, which is now negligible.

One of the most difficult appendectomy operations was performed on April 30, 1961 by the doctor of the sixth Antarctic expedition L. I. Rogozov on himself ^[7]

• Human appendix

• Human anatomy: study. : in 2 volumes / E. I. Borzyak, E. A. Dobrovolskaya, V. S. Revazov; Ed. Sapina M. R .. - M .: Medicine, 1986. - T. 1. - 228 p. : ill. - (Textbooks for medical students). - UDC .

• Appendicitis (neopr.) . Universal popular science encyclopedia Krugosvet .
• Appendectomy (neopr.) . Medical Encyclopedia Medical-Enc.ru .