An appendectomy is the surgical removal of a patient’s appendix, a small tube attached to the colon. Most appendectomies are performed to treat an inflamed appendix (appendicitis). Left untreated, appendicitis can cause the appendix to rupture. This, in turn, may result in a potentially life-threatening infection of the inner lining (peritoneum) of the abdomen called peritonitis.
An appendectomy is almost always performed as an emergency treatment. Most people are unaware they have appendicitis until the symptoms become severe. Symptoms of appendicitis include pain in the lower right abdomen, fever, loss of appetite, nausea and vomiting.
There are two major types of appendectomy procedures: traditional open surgery and laparoscopy. For both, patients are given general anesthesia and are not awake during the procedure. Traditional open surgery involves making an incision in the patient’s lower right abdomen and removing the appendix using surgical instruments. This technique is commonly used, particularly when a patient’s appendix has already ruptured.
Laparoscopic surgery requires just a few tiny incisions into the abdomen. A thin tube with a light and camera called a laparoscope is inserted into one of the incisions. The surgeon uses a monitor to watch the image of the appendix provided by the laparoscope and is able to remove the appendix through one of the incisions with minimum scarring.
Patients who have traditional open surgery usually spend one to three days in the hospital, whereas those who undergo laparoscopy are likely to be discharged from the hospital the same day of the procedure. Full recovery takes several weeks. Most patients do not have to make diet, exercise or other lifestyle changes following an appendectomy.
In rare cases, people who have undergone an appendectomy can experience “stump appendicitis,” inflammation of the tiny part of the appendix that remains after surgery. In such cases, a second surgery may be needed to remove the remainder of the appendix. Leaving a stump less than 3 millimeters long in the original surgery may prevent stump appendicitis.
About appendectomies
An appendectomy is the surgical removal of the appendix, a long, thin pouch attached to the colon on the right side of the abdomen. This procedure is the standard treatment for appendicitis (an inflammation of the appendix) and is the most common emergency surgical procedure of the abdomen, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The appendix is a tube attached to a portion of the intestines called the cecum. It has no known function and its removal usually presents no problems.
Many different conditions can trigger appendicitis, including infection of the digestive tract, in which bacteria invade the appendix. Blockages of the appendix, by bacteria or sometimes by feces moving through the intestines, may also cause appendicitis. When treated promptly, appendicitis poses little threat to the patient. However, if the appendix ruptures before it is removed, infection of the inner lining of the abdomen (peritoneum) can develop into a potentially serious condition known as peritonitis. In rare cases, peritonitis can result in death.
Appendicitis is a serious and potentially life-threatening condition. Patients who have any of the symptoms associated with appendicitis are urged to seek immediate medical care. Such symptoms include pain in the lower right abdomen, fever, loss of appetite, nausea and vomiting. Patients should not treat these symptoms at home using heating pads, enemas, laxatives or other remedies. Almost all appendectomies are performed as emergency procedures because the symptoms develop within a few hours.
A physician who diagnoses appendicitis will virtually always recommend an appendectomy because of the potentially life-threatening danger that the untreated condition presents. In about 10 to 20 percent of all cases, the surgeon will discover during the operation that the appendix is actually healthy and is not the source of the patient’s symptoms. In such instances, the appendix is usually removed anyway as a preventive measure. The surgeon will then examine the abdomen for another potential source of illness.
In some cases, a patient’s burst appendix will result in an abscess, an area of infection that is walled off from the rest of the body. In such situations, a physician may drain the abscess for up to several weeks before an appendectomy is performed.
Types and differences of appendectomies
There are two major types of appendectomy procedures: traditional open surgery and laparoscopy.
Traditional open surgery involves making an incision in the patient’s lower right abdomen and removing the appendix using surgical instruments. This technique is used in many appendectomies, particularly when a patient’s appendix has ruptured. Open surgery allows the surgeon greater access to the abdominal cavity, which may require cleaning with fluid if infectious material has entered the cavity following a ruptured appendix. Other factors that make open surgery more likely than laparoscopic surgery include:
Extensive infection or abscess
Obesity
History of prior abdominal surgery that has resulted in dense scar tissue
Inability to see the organs using a laparoscope
Bleeding problems that develop during laparoscopic surgery
Laparoscopic surgery requires just a few small incisions into the abdomen. A thin tube called a laparoscope is inserted into one of the incisions through a hollow instrument called a cannula. The laparoscope has an attached camera and light that provide a magnified view of the interior of the abdomen. The surgeon views the image on a monitor and inserts instruments into the other incisions to remove the appendix with minimum scarring.
Before the appendectomy
In most cases, an appendectomy is an emergency medical procedure. Appendicitis occurs suddenly and typically develops over a six- to 12-hour period. Patients may experience abdominal pain, fever, nausea and vomiting, reduced appetite, and other symptoms that gradually worsen and eventually cause them to seek medical care.
A physician may suspect appendicitis if the patient reports symptoms typically associated with the condition. To help confirm the diagnosis, the physician may test the patient’s blood for an elevated white cell count, which indicates the presence of an infection. A urine test can also help detect other conditions that might cause similar symptoms, such as a kidney stone (painful, solid mass of crystal in the kidney) or urinary tract infection (infection of the kidneys, ureters, bladder or urethra that is usually due to bacteria).
Imaging tests can help confirm the presence of appendicitis or another disease. These may include an abdominal x-ray, an ultrasound scan (which uses high-frequency sound waves to create an image) or a computed axial tomography (CAT) scan (which uses a series of computer-generated x-rays to form a detailed image).
Because of the sudden nature of appendicitis, there is usually little time to prepare for an appendectomy. Once the physician has determined that appendicitis is the likely cause of a patient’s symptoms, emergency surgery will be scheduled. It is important to remove the appendix promptly before it ruptures, which can cause serious health problems. Patients will typically be asked when they last ate a meal, because an empty stomach is needed before the patient can be given the general anesthesia for the procedure. Patients will also be asked about any medications they are taking and whether or not they are allergic to anesthesia.
During the appendectomy
Before an appendectomy, patients typically receive a sedative that makes them sleepy. An intravenous (I.V.) needle is inserted in the back of their hand or forearm and is attached to an I.V. line. General anesthesia is administered through this line. Patients who receive general anesthesia will be unconscious and not experience any pain during the procedure.
During open surgery, a small incision is made through the skin and fat of the right lower part of the abdomen. The muscles are then separated, allowing the surgeon to access the peritoneum. The surgeon cuts the peritoneum to reveal the section of the large intestine that is attached to the appendix (known as the cecum). The surgeon moves the small intestine aside, separates the appendix from surrounding structures and ties off the blood vessels surrounding the site.
Once this has been accomplished, the appendix is removed from the body. Sutures or tiny staples are used to close the peritoneum, muscle wall and skin.
During the laparoscopic technique, three or four small incisions of about one-quarter inch to one-half inch (0.64 centimeters to 1.27 centimeters) in length are made in the patient’s abdomen. The laparoscope is inserted through a long tube called a cannula into one of the incisions. The light and camera attached to the laparoscope are used to project an image of the abdominal cavity onto a monitor. The surgeon uses this image to locate and remove the appendix with instruments that are inserted through cannulas into the other incision points. In some cases, these incision points may need to be lengthened to complete the procedure. Once the appendix has been removed, these incision points are sutured shut.
If the appendix has ruptured, the patient will require an open surgery. If the rupture is discovered during laparoscopy, the surgeon needs to create an open incision to inspect the rest of the abdomen. The surgeon may wash the abdomen with fluid and immediately begin a course of antibiotics for the patient that will last for several days. Both open and laparoscopic appendectomies take about an hour to complete.
After the appendectomy
Patients are likely to remain in the operating room for about an hour following the procedure. In most cases, patients who have had open surgery spend one to three days in the hospital. However, a patient recovering from a ruptured appendix may remain in the hospital longer. A drain may remain in their incision for several days, and patients should keep their incision site dry and clean to avoid infection. They will also be monitored for any other complications that may arise, such as bowel blockage.
Patients who have laparoscopic surgery are likely to be discharged from the hospital the same day of the procedure. Patients should not drive, but instead should have a friend or family member take them home.
Recovery from appendectomy usually takes several weeks, although the exact amount of time required will depend on the type of procedure performed. As with any surgery, patients may experience minor pain and discomfort during the healing process, and over-the-counter pain medication may be recommended. If laparoscopy is used, recovery time is quicker, and less pain medication is typically required. In general, patients are advised to avoid strenuous activity, such as exercise or lifting heavy objects, for between four and six weeks. However, light exercise, such as walking, may be recommended.
The vast majority of patients make a full recovery and do not need to make diet, exercise or other lifestyle changes. Patients are likely to have a scar following surgery, but it is usually very small.
In rare cases, people who have undergone an appendectomy can experience “stump appendicitis,” inflammation of the tiny part of the appendix that remains after surgery. In such cases, a second surgery may be needed to remove the remainder of the appendix. Leaving a stump less than 3 millimeters long in the original surgery may prevent stump appendicitis.
Potential risks with appendectomy
Appendectomies carry all the risks typically associated with all forms of surgery. These include patient reaction to anesthesia (such as allergic reactions or breathing problems), bleeding and infection.
Patients should immediately contact their physician if they experience any of the following after an appendectomy:
Persistent fever of 101 degrees Fahrenheit (39 degrees Celsius)
Bleeding
Increased abdominal swelling
Pain that is not relieved by medications
Persistent nausea or vomiting
Chills
Persistent cough or shortness of breath
Pus drainage from any incision
Worsening redness around incisions
Inability to eat or drink liquids
Inability to pass gas or have a bowel movement
Questions for your doctor on appendectomies
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to appendectomies:
Are you certain I need an appendectomy?
How many appendectomies have you performed?
What are the differences between the two major types of appendectomy?
How long will my surgery last?
Can I still have laparoscopy if my appendix has ruptured?
How long will I have to remain in the hospital after the procedure?
How long will my recovery period last?
What will my recovery period involve?
Will I have to alter my lifestyle following the appendectomy?
