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Appendectomy
(Removal of the appendix)

Appendicitis is the most common abdominal surgical emergency 

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Appendicitis

  • Appendicitis is the most common abdominal surgical emergency

  • Appendicitis means “inflammation of the appendix”

  • The appendix is a narrow finger shaped 
    pouch that projects out from the colon (large intestine) on the lower right side of your abdomen

  • If the appendix becomes blocked and swollen, bacteria can grow in the pouch. The blocked opening can be from an illness, thick mucus, hard stool, or a tumor.

  • This leads to backup of fluid in the appendix, causing it to dilate and eventually it can perforate (“burst”). This leads to bacteria and stool being released into the abdomen.

  • A perforation may lead to an abscess formation which may need extended hospital stay and IV antibiotics

  • Most commonly affecting patients between the ages of 10-30 years old

appendicitis

Symptoms

  • Sudden pain that begins around your navel and often shifts to your lower right abdomen
  • Pain that worsens if you cough, walk or make other jarring movements
  • Nausea, vomiting, loss of appetite
  • Low-grade fever that may worsen as the illness progresses

Common Tests

  • Blood tests are commonly performed to check for infection 
  • Urine sample may be taken
  • CT is the best imaging to look for appendicitis 

Treatment of appendicitis

  • Surgical intervention – laparoscopy appendectomy or open appendectomy
    • Most commonly recommended approach to most cases of appendicitis
  • Antibiotics alone
    • May be recommended instead of surgery in certain situations. Your doctor will discuss this with you. This can be effective but has a higher failure and reoccurrence rate compared to surgery.
  • Drainage of abscess without removal of the appendix 
    • Sometimes, if your appendix has been perforated with an abscess (pocket of infection inside your abdomen), the risks of surgery outweigh the benefits. In these cases, the abscess is commonly drained with a tube that an interventional radiologist places, and you are kept on antibiotics in the hospital. This is typically successful without removing your appendix during your hospital stay.
    • It is common for your surgeon to offer an “interval appendectomy” which means removing the appendix months later, when the inflammation is gone and you are feeling back to normal. This is a discussion between you and your surgeon.

Surgery (Laparoscopic appendectomy)

  • Most common operation, low risk
  • 3 small incisions with hollow tubes placed to use instruments and a lighted camera
  • Carbon dioxide is used to make space between your organs to work with small instruments
  • The blood vessels leading to your appendix are divided
  • The appendix is stapled at the base (where it comes off your colon)
  • The appendix is placed into a bag and removed from your abdomen
  • The appendix is sent to the pathologist to examine under a microscope

Surgery (Open appendectomy)

  • One incision in your right lower abdomen
  • The blood vessels leading to your appendix are divided 
  • The appendix is stapled at the base (where it comes off your colon)
  • The appendix is removed from your abdomen
  • The appendix is sent to the pathologist to examine under a microscope

Risks

  • Bleeding, damage to surrounding structures
  • Infection risk is very low if not perforated, but can be near 30% if perforated
  • Anesthesia-related risks (heart, lung complications and blood clots)
  • Your risk of complications depends on your overall health and the severity of your appendicitis

Results

  • After surgery you will not have the symptoms you were having from appendicitis
  • If your appendix is perforated, you will stay in the hospital for IV antibiotics
  • Most people recover quickly from surgery with no complications

What to expect

Preparing for your surgery

  • This is typically an emergent surgery, with surgery occurring the same day as your diagnosis.

    Day of Surgery

    • You will receive general anesthesia and have breathing tube (endotracheal tube) put down during surgery. You will be completely asleep for this and the tube is removed before you wake up. The anesthesia provider will meet with you before surgery
    • Most people go home within a few hours after surgery if the appendix is not perforated
    • If the appendix was perforated, you will likely be admitted to the hospital for IV antibiotics and close monitoring for a few days.
    • You will need someone to drive you home and be close for the first night following your surgery

    Postoperatively

    • Eat normal diet, start with bland foods. Ensure you are drinking 8-10 glasses of water a day after surgery. Eat high-fiber foods or take fiber supplement (ex. Metamucil) to help with your bowel movements after surgery.
    • It is normal to have pain, especially in your shoulder/neck and with deep breathing. This is from the gas used during surgery and will resolve within a couple days. Changing positions can help.
    • You will be sent home with pain medications which most people will take for a few days after surgery then are able to wean to non-narcotic mediations
    • Take ibuprofen (unless you have a medical reason not to) in addition to help decrease the amount of narcotic you are taking.
    • Norco (the narcotic most commonly prescribed) has Tylenol in it. Either take norco OR Tylenol in addition to the ibuprofen.
    • Take stool softeners and/or laxatives as needed (docusate, miralax) to help your bowels stay regular following surgery. Anesthesia and pain medications can contribute to constipation postoperatively.
    • Walk around as able. Take deep breaths to fully expand your lungs. This can help prevent pneumonia and blood clots
    • Slowly increase your activity. You are typically ready for normal activity by 1-3 weeks after your surgery.
    • Most people will be able to return to work or school about 5-7 days after surgery. 
    • Wound care 
    • All sutures used will be buried under the skin and absorbable.
    • If you have steri strips over your incisions. Remove bandaids in 24-48hrs after surgery. Leave white strips (steri strips) in place and shower. Let soapy water run over these and pat dry. They will begin to peel off in about 7-10 days then you may remove.
    • If you have skin glue (dermabond) over the incisions you may shower immediately. When this begins to flake off you may peel off, typically in a week.
    • Do not bathe, soak incisions, go in hot tube, pool or lake/ocean for 2 weeks.
    • Your scar with heal over the next 4-6 weeks and continue to fade and soften over the next year. Use sunscreen over incisions when exposed to sun for the next year.

    When to Call

    • Severe or worsening uncontrolled pain
    • A fever >101.3
    • Continuous vomiting
    • Foul smelling drainage, redness or continued bleeding from an incision sites
    • Chest pain or trouble breathing (call 911 or go to the ER)
    • Any questions or concerns

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