About Appendectomy

Appendectomy is the surgical removal of the appendix. This brochure will explain why you may need an appendectomy and what to expect before and after the operation.

What is the Appendix?

The appendix is a three to six inch long tubular structure that is attached in the area of the junction of the large and small intestines. The appendix has no known function. Once the appendix becomes inflamed, it must be removed. The appendix may vary in its location in the abdomen and its relationship to other parts of the intestinal tract. This variation accounts in part for the variety of symptoms that can make diagnosis a challenge.

What is Appendicitis?

Obstruction of the appendix by fecal matter or some other cause can lead to inflammation called appendicitis. Appendicitis usually develops rapidly with little warning over the course of six to twelve hours. The usual symptom is abdominal pain, which begins as a vague discomfort around the navel. Over the next several hours, the pain becomes much more severe and is localized to the lower right side of the abdomen. The abdomen may become rigid and very sensitive to pressure. The pain may be accompanied by loss of appetite, nausea or vomiting. In advanced cases, the appendix may rupture and can lead to more serious infection.

Who gets Appendicitis?

Approximately two thirds of all people who get appendicitis are women, and about two thirds of all people who get appendicitis are between the ages of 15 and 44. However, the condition can affect any person at any age.

Diagnosing Appendicitis

Since appendicitis is an emergency situation, diagnosis is based primarily on symptoms and the physical exam. The white blood count may be elevated. If there is a question about the diagnosis and the condition does not appear urgent, other xrays and tests may be ordered.

Preparing for Surgery

The procedure is done under a general anesthesia and therefore, it is important that you not eat or drink anything prior to surgery. An intravenous line will be inserted into your arm for giving antibiotics, fluids and the anesthetic. The operation usually takes about an hour.

The Surgical Procedure

The surgical procedure can be performed in two different ways: through an open operation or with a laparoscopic technique.

The Open Technique

In this operation, the surgeon makes a short incision through the skin and underlying fat. The muscles of the abdominal wall are then separated, allowing entry into the abdominal cavity. The abdominal organs in the area are inspected. The appendix is separated from the intestine and removed from the abdomen. The abdominal wall is then closed in layers with sutures. If the appendix has ruptured and there is a significant amount of contamination, the skin may be left open to prevent a wound infection.

The Laparoscopic Technique

A camera is inserted through a small incision in the umbilicus and is used to view the interior of the abdominal cavity. The surgeon can perform the appendectomy while viewing the image displayed on the TV monitor. Surgical instruments are placed through two other small incisions. The laparoscopic approach may let patients recover faster and results in less visible scarring. This technique also allows better visibility than that obtained through the typical appendectomy incision. Occasionally the appendix can not be successfully removed with a laparoscopic technique, and it may be necessary to proceed with an open technique.

Recovery

You will stay in the recovery room for about an hour after your surgery. You will be up and walking within six hours. In the uncomplicated appendectomy, you can expect to go home in one or two days.

If the appendix has ruptured, you may be hospitalized for several days. The incisions are usually quite strong and one can usually resume normal activities as the soreness decreases. You will be given pain medication to take after you leave the hospital.

Complications

Complications fortunately are rare, but since they do occur, we feel it is important that you know about them.

The most common complication that may occur is infection of the abdominal cavity or wound. This is particularly common in those who have ruptured appendicitis and may require another surgery to drain the infection. It is possible that, upon exploration of the abdominal cavity, you will be found to have a normal appendix. This is not uncommon, and the appendix will usually be removed to prevent confusion in the future.

Other problems that can mimic appendicitis may be encountered. If your surgeon finds one of these conditions, usually it will be dealt with at the time of surgery.

Complications can also include bleeding, injury to organs, conversion from laparoscopic to open surgery, and complications from anesthesia.

Call your surgeon if you have fever over 100.4 degrees F, worsening pain, unrelenting nausea or vomiting, worsening abdominal bloating, or signs of infection.