What is an appendectomy?
An appendectomy is a surgery to remove the appendix. The appendix is a three to six-inch long pouch-like structure in the lower right area of the abdomen. It is attached to your intestines. Appendicitis occurs when the appendix becomes infected or inflamed. Appendicitis can cause severe abdominal pain and infection. An appendectomy cures appendicitis and eliminates its symptoms.
The function of the appendix is not entirely clear. It contains lymphoid tissue and may help the body fight infection. Other organs take over the infection-fighting work of the appendix after it is removed. You will have the same level of immunity as you did when you had an appendix.
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An appendectomy can be a life-saving surgery, but it has risks and potential complications. You may require other treatments before surgery if your appendix has burst (ruptured). This includes antibiotics and placing a tube through your abdomen to drain pus from around the ruptured appendix.
Why is an appendectomy performed?
The appendix extends out from the large intestine (the colon). The appendix can trap food, stool or ingested objects due to its location. This causes irritation, inflammation, rapid growth of bacteria, and infection (appendicitis). Removal of the appendix is the cure for appendicitis.
An inflamed or infected appendix may rupture if it is not removed. This can result in a collection of pus (abscess) around the appendix. Infection can also spread throughout the abdomen. This is a life-threatening condition called peritonitis. An appendectomy is often needed on an emergency basis without much warning to prevent to treat peritonitis.
Who performs an appendectomy?
A general surgeon or pediatric (children's) surgeon performs appendectomy surgery. A general surgeon specializes in the surgical care of diseases, injuries and deformities affecting the abdomen, breasts, digestive tract, endocrine system and skin. A pediatric surgeon is a general surgeon with extra training in performing surgery on infants, children and adolescents.
How is an appendectomy performed?
Your appendectomy will be performed in a hospital. Your surgeon makes a large incision (open surgery) or several smaller incisions (minimally invasive surgery) in your abdomen. Your surgeon cuts out the appendix and ties off blood vessels. The abdomen is cleaned out if the appendix is ruptured, and a drain may be placed to remove fluid remaining in the abdomen. It is usually removed before you leave the hospital.
Surgical approaches to appendectomy
Your surgeon will perform an appendectomy using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and a laparoscope through small incisions in the abdomen. The laparoscope is a thin, lighted instrument with a small camera that sends pictures of the inside of your body to a video screen. Your surgeon sees the inside of your abdomen on the screen while performing the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon makes several small incisions instead of a larger one used in open surgery. Your surgeon threads surgical tools around structures, such as muscle, instead of cutting through or displacing them as in open surgery.
Open surgery involves making a large incision in the abdomen. Open surgery allows your surgeon to view and access the surgical area directly. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. This is because it causes more trauma to tissues. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon may decide after beginning a minimally invasive procedure that you need open surgery to complete your surgery. This may occur if you have severe bleeding or your surgeon finds a serious infection, abscess, or a ruptured appendix.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different appendectomy procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform an appendectomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and will not feel any pain.
You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your appendectomy
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have
A surgical team member starts an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
A team member inserts a tube through your mouth or nose into your stomach to keep your stomach empty. A catheter is placed into your bladder to collect urine and monitor kidney function. You will not feel or remember these procedures as they happen.
The surgical team monitors your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of an appendectomy?
As with all surgeries, an appendectomy involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications are can develop during the surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of appendectomy
Complications of appendectomy include:
Constipation or obstruction of stools through the intestines (bowel obstruction)
Damage to other abdominal organs
Development of scar tissue on the intestine, which could cause a bowel obstruction
Intestinal leakage through the parts that were sewn or stapled together after cutting out the appendix
Opening or infection of the abdominal incision
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery.
Informing your doctor if you are nursing or there is any possibility that you may be pregnant
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my appendectomy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. Many appendectomies are performed without much warning because appendicitis can progress rapidly. When you have advanced notice of surgery, you can prepare for appendectomy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Pre-operative testing may include an ultrasound, CT scan, chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Your surgeon will restrict eating or drinking just prior to surgery. Your surgery may be cancelled if you eat or drink too close to the start of the procedure because you can choke on stomach contents during anesthesia.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your medications and supplements. You may also need to take antibiotics, enemas, or a special bowel preparation medication before surgery to reduce bacteria in the colon.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit or in an emergency situation. You may also think of other questions after your appointment. Contact your doctor with any concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need an appendectomy? Are there any other options for treating my condition?
What type of appendectomy procedure will you perform?
How long will the surgery take? When can I go home?
What kind of diet will I follow after surgery?
What restrictions will I have after surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
How do I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular office hours.
What can I expect after my appendectomy?
Knowing what to expect can help make your road to recovery after appendectomy as smooth as possible.
How long will it take to recover?
You will stay briefly in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may go home the same day of your surgery after a laparoscopic appendectomy. You will stay in the hospital for one to three days or longer if your appendix ruptured before it was removed.
Your surgical and medical teams will monitor your healing and help you transition back to eating and drinking. You will be given clear liquids within about a day. If you can tolerate those, you will consume increasingly thicker liquids, and then solid foods.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, your general health, age, and other factors. Full recovery takes up to a month.
Will I feel pain?
Pain control is important to healing and a smooth recovery. There will be discomfort after your procedure, including a sore incision(s). Your doctor will treat your pain so you are comfortable and can get the rest you need.
Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after appendectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
- Bleeding from the wounds
- Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
- Change in alertness, such as passing out, unresponsiveness, or confusion
- Chest pain, chest tightness, chest pressure, or palpitations
- Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
- Inability to urinate, have a bowel movement, or pass gas
- Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
- Pain that is not controlled by your pain medication, new pain, or severe abdominal pain
- Severe nausea and vomiting
- Sudden and new abdominal swelling
- Unexpected drainage, pus, redness or swelling of your incision(s)
How might appendectomy affect my everyday life?
An appendectomy cures appendicitis and eliminates it symptoms. People generally return to normal activities such as exercising, working and traveling, after a full recovery.
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- Acute Appendicitis. Better Medicine. http://www.bettermedicine.com/article/acute-appendicitis
- Appendectomy. American College of Surgeons. http://www.facs.org/public_info/operation/brochures/app.pdf
- Appendectomy. KidsHealth.org. http://kidshealth.org/parent/system/surgery/appendectomy.html
- Patient Information for Laparoscopic Appendectomy from SAGES. Society of American Gastrointestinal and Endoscopic Surgeons. http://www.sages.org/publication/id/PI08/