What is an Appendectomy?

An appendectomy is the surgical removal of the appendix. The appendix is a finger-like pouch attached to the large intestine and located in the lower right area of the abdomen. The exact function of this organ is not clear.

Appendectomy can be performed either as an open surgery or as a laparoscopic surgery. The open method involves a 2- to 3-inch surgical cut in the lower right side of the abdomen to remove the appendix, whereas the laparoscopic technique involves several small keyhole incisions in the abdomen and the use of a laparoscope and miniature surgical instruments to remove the appendix. The laparoscope is a small, thin tube with a light and tiny video camera (connected to a television monitor) attached at the end, which helps visualise inside the abdomen during the operation.

Indications for Appendectomy

Appendectomy is usually recommended for the treatment of a condition called appendicitis. Appendicitis is a condition in which the appendix becomes inflamed and filled with pus. It is a medical emergency requiring immediate surgical removal of the appendix. If it is left untreated, there are chances the appendix may burst open spreading the infectious material into the abdominal cavity (peritoneum). This can inflame the abdominal cavity, a condition called peritonitis, and can sometimes be fatal if not treated urgently. Appendicitis can occur at any age, but is common between the ages of 10 and 30 years.

Preparation for Appendectomy

Before the procedure, your doctor will briefly explain the entire procedure. You will be offered the opportunity to ask any questions that you may have about the procedure. Your doctor will obtain your entire medical history, perform a thorough physical examination, and obtain blood and other diagnostic tests to check for any abnormality. You should notify your doctor about your medications, allergies, or any other existing medical condition. You will be instructed to be on an empty stomach for at least 8 hours before undergoing the procedure. Your doctor will instruct you on specific preparation depending on your condition. A signed informed consent will be finally obtained.

Procedure for Appendectomy

Appendectomy can be performed either with a traditional open surgical method or as a minimally invasive laparoscopic method.

Open Surgery

You will be given general anaesthesia, which means you will be asleep throughout the entire procedure. A 2-to 3-inch incision will be made in the lower right portion of your abdomen. Your abdominal muscles will be separated through retractors and an entryway will be created into your abdominal cavity. On entering into the abdominal cavity, your appendix will be located. Your appendix will then be tied off with sutures and removed. If your doctor finds your appendix to be ruptured, he or she will wash your abdomen thoroughly with saline and place a small tube in the incision to drain out any fluids or pus. Your surgeon will then close the lining of your abdominal cavity and abdominal muscles with stitches. Your doctor will close your skin incision with sutures or surgical staples and apply sterile dressings over the surgical wound.

Laparoscopic Surgery

A laparoscopic surgery is also performed under general anaesthesia and involves several smaller incisions, a laparoscope, and special surgical tools to remove the appendix. During a laparoscopic surgery, your surgeon will make small incisions in the abdomen and insert a laparoscope and other tiny instruments through them. The laparoscope has a lighted camera, which will help your surgeon view the operation site on a large monitor. A gas will be pumped in to separate the abdominal walls from the other organs and allow better visibility. With the images from the laparoscope as a guide, your surgeon will determine the extent of the problem and then remove the appendix. Once the appendix is removed, the area is washed with sterile fluid to minimise the risk of infection. The tiny incisions are closed and covered with small bandages. Laparoscopic surgery has several advantages over open surgery including less pain, fewer complications, and a shorter recovery time.

Postoperative Care and Recovery

After the surgery, you will be transferred to the recovery area where your nurse will monitor your vital signs as you recover from the anaesthetic effects. You may need to stay in the hospital for about 1 to 3 days depending on the method of surgery performed. You will be given antibiotics and pain medications by your doctor to address surgery-related infection, pain, and discomfort. It is quite normal to feel constipated and you will be prescribed medicines for the same by your doctor. You will be instructed on proper wound care and activity restrictions. Instructions on diet and bathing will also be provided. You may return to your normal activities in a week or two after your procedure. You will need to avoid strenuous activities for four to six weeks following surgery. Your doctor will make arrangements for your follow-up visits, usually a week or two after your surgery, during which your stitches or bandages will be removed.

Risks and Complications

Appendectomy is a relatively safe surgery; however, as with any surgery, some risks and complications may occur, such as:

  • Wound infection
  • Bleeding under the skin (hematoma)
  • Scarring
  • Hernia
  • Blood clots
  • Adverse reactions to anaesthesia
  • Abscess (collection of pus/bacteria)
  • Damage to adjacent organs such as bladder and intestines
  • The Clementine Churchill Hospital
  • NHS Royal Free London
  • UCL
  • NHS London North West
  • Royal College of Surgeons of England