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Definition

Surgical removal of the appendix, which is a small tube-like projection that is attached to the large intestine

Parts of the Body Involved

  • Appendix
  • Abdomen
  • Large intestine

Reasons for Procedure

An appendectomy is most often performed as an emergency operation to treat appendicitis . Appendicitis is inflammation of the appendix, which can result from an infection or obstruction.

Inflamed Appendix

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Appendectomy is sometimes done to remove a malignant tumor in the appendix.

The appendix may also be removed in some patients having surgery for another disorder, such as Crohn's disease . This is done to avoid confusing the diagnosis later on, since Crohn’s disease can mimic appendicitis. This is called an incidental appendectomy.

Risk Factors for Complications During the Procedure

One major risk factor is a delay in receiving treatment. The appendix can rupture any time after symptoms begin. If the appendix ruptures and its contents spill into the abdomen, infection and inflammation can occur. This is called peritonitis . The combination of stool spillage and peritonitis can result in a collection of pus, called an abscess. If the appendix has ruptured and an abscess is present, you may be given antibiotics for 7-10 days to fight the infection. Surgery may be postponed until the inflammation goes down. Alternatively, the abscess may be drained using catheters inserted via CT scan or ultrasound .

Other risk factors include:

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Blood tests
  • Urine analysis
  • X-rays
  • Ultrasound —a test that uses sound waves to find the appendix and other organs
  • CT scan—a type of x-ray that uses a computer to make pictures of the inside of the body
  • Antibiotics will be started right away

Since appendicitis is an acute condition, surgery is almost always done on an emergency basis.

During Procedure

IV fluids, anesthesia, possibly a sedative

Anesthesia

General anesthesia will be used. You will be asleep with a temporary breathing tube in place.

Description of the Procedure

The surgeon can remove your appendix using one of two methods: an open technique or a laparoscopic removal.

For the open technique, the surgeon makes a short incision in the right lower abdomen. For a laparoscopic removal, small tubes (called trocars) are inserted and carbon dioxide gas is pumped into your abdomen. This gas inflates your abdomen and makes it easier for the surgeon to see the surrounding organs and operate. The surgeon makes three small openings on the abdomen. A long camera is inserted through one of the trocars. This camera is a laparoscope, which lights, magnifies, and projects an image of the internal organs onto a video screen. Through the other two trocars, the surgeon inserts an instrument to lift the appendix and a stapler to cut the appendix off.

With both methods, the surgeon detaches the appendix from surrounding tissue and stops any bleeding from blood vessels. The appendix is tied off and cut out. The surgeon covers the remaining stump and closes the incisions with stitches or staples.

If the appendix has ruptured, the surgeon will use warm saline solution mixed with antibiotics to wash out the inside of the abdomen. A catheter is then placed to drain any fluid that accumulates. Sometimes, if the appendix has ruptured, the surgeon will only close the muscle layers and leave the skin open. The open skin wound is then packed with a moist gauze dressing. This dressing is changed on a daily basis. The open skin wound gradually closes on its own; usually in 5-10 days.

After Procedure

The removed tissue is examined by a pathologist.

How Long Will It Take?

1-2 hours

Will It Hurt?

Anesthesia prevents pain during surgery. You may be given pain medication to relieve pain and soreness during recovery.

Possible Complications

  • Infection, including peritonitis
  • Intra-abdominal or pelvic abscess
  • Hemorrhage
  • Anesthesia-related problems
  • Bowel obstruction
  • Injury to the bowel, ureter, or nearby organs

Average Hospital Stay

You may be in the hospital for 0-3 days, depending on the type of surgery. With laparoscopic surgery, you may go home the same day. If the appendix has ruptured, expect to stay for several days or more than a week depending on the severity of the infection.

Postoperative Care

  • You'll get out of bed about six hours after surgery.
  • You may resume your normal preoperative diet as soon as feasible.
  • You may be given antibiotics to fight infection; take all the medications ordered, even if you start to feel better.
  • Keep the incision area clean and dry.
  • Wash your hands before changing the dressing.
  • If your appendix ruptured, drainage tubes will be removed after a few days.
  • Rest and take it easy for 1-2 weeks.
  • Do not exercise or do heavy lifting for one or more weeks as directed by your doctor.
  • Gradually increase activities as approved by your doctor.

Outcome

Recovery takes about 4-6 weeks for open appendectomy, and 1-2 weeks for laparoscopic appendectomy. The appendix has no apparent purpose, so you can live without one.

NOTE: If the appendix had ruptured, you are at an increased risk of complications and recovery may take longer.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Increased abdominal pain
  • Fainting or dizziness
  • Passing blood in the stool