Appendectomy Essay

Appendectomy is the surgical removal of the appendix, which is a long narrow tube that attaches to the first part of the colon. It’s located in the lower right side of the abdomen. The appendix is a vestigial organ, and it has no known relevant function.

Weight loss surgery, also known as bariatric surgery is recommended by many physicians to people who are unable to benefit from traditional weight loss methods. However, choosing to undergo weight loss surgery isn’t an easy decision. It is an important decision that will drastically and permanently impact a person’s life. Therefore, before making such a significant decision, an individual should be aware of both the risks and benefits associated with weight loss surgery (McGowan & Chopra ix).

Surgeons’ have an easy approach to doing the surgery. They have more of the right tools to do the procedure with. It results in the surgery being done correctly. Those who have gastric bypass know it is not an easy ticket out. This surgery is to help reduce and keep weight off; those that experienced it have to manage their diet, physical activity and psychological change. There required to think positive about their weight loss approach. Although, many insurers cover this surgery (“Is”). Most people who qualify are afraid to get the procedures, but bariatric surgery has been proven to be effective” Is gastric surgery the solution to America’s Obesity problem? Well for most of it yes, according to research more people are starting to get gastric surgery than a little bit. There are more people who have decided to get this procedure done. However, obesity may explain why weight loss interventions accumulate financial and social support in the past may prove to be the ultimate expansion of gastric surgery

Table 3 shows descriptive statistics of 22,174 colectomy cases that include 4,498 partial laparoscopic colectomies, 16,689 partial open surgery colectomies and 987 total open surgery colectomies. The unadjusted average colectomy price of the sample was $20,421, which is lower than the unadjusted average colectomy price ($26,081) for Medicare patients. Age and disease severity of Medicare patients are much higher than those of privately insured patients. The mean age of the sample was 51.41 and 49.6 percent of the colectomy patients were male.

According to the United States, two hundred million Americans are currently obese or overweight. The prevalence of obesity in the general surgical population is approximately 30 percent of both children and adult patients. Every year an increasing number of obese patients undergo

QRTC= quasi-experimental -nonrandomized controlled trials CD=cross-over design CS=case series PCS= prospective cohort study RCS=retrospective case series MA=meta-analysis

If you’ve done your research, you know lap band surgery is expensive. On the other hand, not all insurance plans offer the coverage you need to reduce some of the costs. For those in serious need of weight loss surgery, needing medical help but not being able to afford it can be dangerous and frustrating.

The number of gastric bypass surgeries has been increased in the last few years and it is considered the ‘‘gold standard’’ of bariatric operations. Bariatric operation or weight reduction surgery is recommended mainly for people whose BMI exceeds 40 kg/m2 as reported by the National Institutes of Health Consensus Development Program, or for those whose BMI is between 35 – 40 40 kg/m2 and who are have life-threatening complications such as cardiac problems (Franco et al., 2011). On the one hand, traditional treatments for weight loss such as lifestyle change do not work for some people. On the other hand, bariatric surgeries have emerged as an effective and safe treatment for obesity; most patients lose 60% of their weight within the first year (Lemmens et al., 2014). Three procedures are commonly performed: laparoscopic Roux-en-Y gastric bypass (LRYGB), the novel laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB). Of these, the Roux-en-Y gastric bypass is the most common (Franco et al., 2011).

The initial plan started with ordering a CBC, CMP, amylase and lipase STAT. These are all standard labs that help to rule out gallbladder pathology as well as our other differential diagnoses. Her vital signs were stable and the physical exam revealed only moderate TTP of the RUQ and epigastric region. The lab results revealed no leukocytosis, no elevation of liver enzymes, bilirubin, amylase, lipase, alk phos or any other signs of cholecystitis, cholangitis, pancreatitis or other potential signs of infection. The plan of care began with keeping the patient NPO. This is recommended as this keeps the patient from further pain secondary to food stimulating gallbladder contraction.5 It also allows the patient to be prepared for surgery if urgent cholecystectomy is required. The next step was beginning IV normal saline to keep her well hydrated. After this we began to give her medication through the IV including Zofran for her nausea. Zofran is an effective anti-emetic and there were no contraindications for use in this patient. We also gave her Morphine 2 mg IV for pain control. Opioids are an effective option for a patient with significant biliary colic.6 Although NSAIDS are another option for pain control, PUD was part of the differential diagnosis so NSAIDS were not an appropriate therapy. We ordered an abdominal ultrasound as this is the diagnostic test of choice for cholelithiasis. The ultrasound revealed multiple gallstones in the gallbladder, some mild gallbladder thickening, and some dilatation of the common bile duct. At this point we consulted GI who scheduled the patient for MRCP in the morning in order rule out choledocholithiaisis. We also consulted the surgery team who admitted the patient. The stated they would likely plan for laparoscopic

Criteria for weight loss surgery will be explained and information on health risks of obesity will be presented. They will be given an opportunity to meet with financial counselors to discuss insurance coverage and financial options. All new members will be given a “Total Support System” membership card. The card will have a client ID number for making appointments and can be used at participating businesses for discounts on local produce, athletic apparel and shoes, Gym memberships, and healthy menu selections at restaurants.

As with any retrospective study, the strength of the conclusions presented in this study are limited by the potential for selection bias. We did employ a multivariate regression analysis to control for possible cofounding variables, but recognize that we could not identify and account for all factors that may have influenced cost. It should also be emphasized that regional variations in surgical care and cost exist, which implies that our conclusions may not be applicable to other institutions. 19 These limitations would be overcome with future prospective randomized controlled studies at various

Biondi, A., Di Stefano, C., Ferrara, F., Bellia, A., Vacante, M., and Piazza, L., (2016), Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness, Available at: https://wjes.biomedcentral.com/articles/10.1186/s13017-016-0102-5 (accessed: 22/06/2017).

The current approaches to surgical management of gallstone ileus are: (1) enterolithotomy, cholecystectomy and fistula repair (single-stage surgery), (2) enterolithotomy with delayed cholecystectomy and fistula closure (two-stage surgery) and (3) simple enterolithotomy (most reported surgical procedure). Proponents of the single-stage procedure cite recurrence and increased risk of developing cholangitis or gallbladder carcinoma as reasons for performing concurrent cholecystectomy and fistula closure [18]. Those who support the two-stage procedure or simple enterolithotomy point to high mortality rates of single-stage procedures and low rates of recurrence and gallbladder carcinoma as reasons

This study was conducted in a 700 bed, tertiary care teaching hospital in the northeastern US. Because the study used only pre-existing post-operative records, the study was declared exempt by the St. Joseph’s Healthcare System Institutional Review Board.

A rising health epidemic that America is currently facing today is obesity. This is becoming very wide spread among all races and class levels due in part to the abundance of inexpensive food available, most notably, fast food restraints . There are literally thousands of diet books available but due to the extreme will power many of these programs demand, more and more people are turning to weight loss surgery as a final solution. The most popular procedures being Gastric Bypass, and Lap Band surgery. Although these are now fairly common procedures with a high rate of success there are also many differences that one should consider when choosing which would be a better fit for themselves . Three of the biggest differences would be