Appendectomy

What is an appendectomy?

An appendectomy is surgery to remove the appendix when it is infected. This condition is called appendicitis. Appendectomy is a common emergency surgery that cures appendicitis.

The appendix is a thin pouch that is attached to the large intestine. It sits in the lower right part of your belly. If you have appendicitis, your appendix is usually removed right away. If not treated, your appendix can burst (rupture). This is a medical emergency.

There are two types of surgery to remove the appendix. The standard method is an open appendectomy. A less invasive method is a laparoscopic appendectomy.

• Open appendectomy. A cut or incision about 2 to 4 inches long is made in the lower right-hand side of your belly or abdomen. The appendix is taken out through the incision.

• Laparoscopic appendectomy. This method is less invasive. That means it’s done without a large incision. Instead, 1 to 3 tiny cuts are made. A long, thin tube called a laparoscope is put into one of the incisions. It has a tiny video camera and surgical tools. The surgeon looks at a TV monitor to see inside your abdomen and guide the tools. The appendix is removed through one of the incisions.

During a laparoscopic surgery, your surgeon may decide that an open appendectomy is needed.

If your appendix has burst and infection has spread, you may need an open appendectomy. If an area of infection called an abscess has formed around the appendix, the surgeon may use antibiotics and drain the abscess before the appendectomy.

A laparoscopic appendectomy may cause less pain and scarring than an open appendectomy. For either type of surgery, the scar is often hard to see once it has healed.

Both types of surgery have low risk for complications. A laparoscopic appendectomy has a shorter hospital stay, shorter recovery time, and lower infection rates. Some studies suggest that intravenous antibiotics alone could treat appendicitis without the need for surgery. But appendectomy remains the standard of care since antibiotics alone do not always cure appendicitis.

Why might I need an appendectomy?

You may need an appendectomy to remove your appendix if you show symptoms of appendicitis.

Appendicitis is a medical emergency. It is when your appendix becomes sore, swollen, and infected.

If you have appendicitis, there is a serious risk your appendix may burst or rupture. This can happen as soon as 48 to 72 hours after you have symptoms. It can cause a severe, life-threatening infection called peritonitis in your belly.

If you have appendicitis symptoms, get medical care right away.

What are the risks of an appendectomy?

All surgery has risks. The risks of an appendectomy include:

• Bleeding

• Wound infection

• Infection, redness, swelling inside the belly (peritonitis) that can occur if the appendix bursts during surgery

• Blocked bowels

• Injury to nearby organs

You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before surgery.

How do I get ready for an appendectomy?

• Your healthcare provider will explain the surgery to you. Ask any questions you may have.

• You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if anything is not clear.

• Your healthcare provider will ask questions about your past health. They will also give you a physical exam. This is to make sure you are in good health before you have surgery. You may also need blood tests and other diagnostic tests.

• You must not eat or drink anything for 8 hours before the surgery. This often means no food or drink after midnight. Sometimes, your healthcare provider may decide that the urgency of having the surgery is more important than when you last ate or drank.

• Make sure your healthcare provider has a list of all medicines (prescribed and over-the-counter) and all herbs, vitamins, and supplements that you are taking.

• You may be given a medicine to help you relax (a sedative) before the surgery.

Tell your healthcare provider if you:

• Are pregnant or think you may be pregnant

• Are allergic to or sensitive to latex, medicines, tape, or anesthesia medicines (local and general)

• Have a history of bleeding disorders or are taking any blood-thinning (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting. You may have to stop taking these medicines before surgery.

Your healthcare provider may have other instructions for you based on your medical condition.

What happens during an appendectomy?

In most cases, an appendectomy is an emergency surgery and will require a hospital stay. You will have either an open appendectomy or a laparoscopic appendectomy. This will depend on your condition and your healthcare provider’s practices.

An appendectomy is done while you are given medicines to put you into a deep sleep (under general anesthesia).

Generally, the appendectomy follows this process:

• You will be asked to remove any jewelry or other objects that might get in the way during surgery.

• You will be asked to remove your clothing and will be given a gown to wear.

• An IV (intravenous) line will be put in your arm or hand.

• You will be placed on the operating table on your back.

• If there is a lot of hair at the surgical site, it may be clipped off.

• A tube will be put down your throat to help you breathe while you are under anesthesia. The anesthesiologist will check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

Open appendectomy

• A cut or incision will be made in the lower right part of your belly.

• Your abdominal muscles will be separated and the abdominal area will be opened.

• Your appendix will be tied off with stitches and removed.

• If your appendix has burst or ruptured, your abdomen will be washed out with salt water (saline).

• The lining of your abdomen and your abdominal muscles will be closed with stitches. A small tube may be put in the incision to drain out fluids.

Laparoscopic appendectomy

• A tiny incision will be made for the tube (laparoscope). More cuts may be made so that other tools can be used during surgery.

• Carbon dioxide gas will be used to swell up your abdomen so that your appendix and other organs can be easily seen.

• The laparoscope will be put in and your appendix will be found.

• Your appendix will be tied off with stitches and removed through an incision.

• When the surgery is done, the laparoscope and tools will be removed. The carbon dioxide will be let out through the cuts. A small tube may be placed in the cut to drain out fluids.

At the end of either method

• Your appendix will be sent to a lab to be tested.

• Your cuts will be closed with stitches or surgical staples.

• A sterile bandage or dressing will be used to cover the wounds.

What happens after an appendectomy?

In the hospital

After surgery, you will be taken to the recovery room. Your healthcare team will watch your vital signs, such as your heart rate and breathing. Your recovery will depend on the type of surgery that was done and the type of anesthesia you had. Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room.

A laparoscopic appendectomy may be done on an outpatient basis. In this case, you may be discharged and sent home from the recovery room.

You will have pain medicine as needed. This may be by prescription or from a nurse. Or you may give it to yourself through a device connected to your IV line.

You may have a thin plastic tube that goes through your nose into your stomach. This is used to remove stomach fluids and air that you swallow. The tube will be taken out when your bowels are working normally. You will not be able to eat or drink until the tube is removed.

You will be asked to get out of bed a few hours after a laparoscopic surgery or by the next day after an open surgery.

You may be allowed to drink liquids a few hours after surgery. You may slowly be able to add more solid foods.

You will schedule a follow-up visit with your healthcare provider. This is often 2 to 3 weeks after surgery.

At home

When you are home, you must keep the incision clean and dry. Your healthcare provider will give you instructions on how to bathe. Any stitches or surgical staples used will be removed at a follow-up office visit. If adhesive strips were used, they should be kept dry. They will often fall off in a few days.

The incision and your abdominal muscles may ache, often after long periods of standing. Take pain medicine as recommended by your healthcare provider. Aspirin or other pain medicines may raise your risk of bleeding. Only take medicines that your healthcare provider has approved.

If you had a laparoscopy, you may feel pain from the carbon dioxide gas that is still in your belly. This pain may last for a few days. You should feel a bit better each day.

Your healthcare provider will likely want you to walk and move around a bit. But don't do any tiring activity. Your healthcare provider will tell you when you can return to work and your normal activities.

Call your healthcare provider if you have any of the following:

• Fever or chills

• Redness, swelling, bleeding, or other drainage from the incision site

• More pain around the incision site

• Vomiting

• Loss of appetite or inability to eat or drink anything

• Constant coughing, trouble breathing, or shortness of breath

• Belly pain, cramping, or swelling

• No bowel movement for 2 days or longer

• Watery diarrhea for more than 3 days

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure