What Is an Appendectomy?

Appendectomy is surgery to remove the appendix, a small tube-shaped organ located in your lower right abdomen. This procedure can be done laparoscopically by inserting tools through very small incisions, or it might require an open procedure (open appendectomy) with a larger incision.

This article discusses techniques used for appendectomy, why it is performed, potential risks and complications, and what to expect during the recovery process.

Appendectomy Techniques

Appendectomy can be performed laparoscopically or as an open procedure using a larger incision. This surgery is done when the appendix becomes inflamed or infected—a condition called appendicitis. Surgery is the primary treatment for this condition, as it can quickly become life-threatening if the appendix bursts.

Laparoscopic appendectomy is the preferred method of surgery for appendicitis. This technique has a faster recovery time and typically causes less postoperative pain than an open procedure. However, if the appendix has burst, an open procedure may be necessary.

Incisions From Laparoscopy

Laparoscopic appendectomy is performed using several tiny incisions in the abdomen (less than one-half inch), just big enough to insert surgical tools. These tools typically include a laparoscope (a small camera with a light at the end of it), a nozzle used to inflate the abdomen with carbon dioxide, and instruments to detach and remove the appendix.

Laparoscopic incisions are closed with a few staples or stitches. In some cases, they are glued shut instead.

Incisions From Open Appendectomy

Open appendectomy uses a larger incision, usually around 2 to 4 inches. This is why it is called an open procedure.

Open appendectomy is performed if the appendix has burst. Other circumstances that can lead to an open procedure include:

• Scar tissue in the abdomen from previous surgeries
• Excessive amounts of fat in the abdomen
• Difficulty visualizing your appendix with a laparoscopic camera
• Abscesses (pockets of pus) on the appendix
• Too much bleeding during an attempt at a laparoscopic procedure

Appendectomy Is Often an Emergency Surgery

Appendicitis symptoms can come on quickly and progress fast. Some people might not have symptoms until the appendix has already burst. Because of this, appendectomies are frequently performed as emergency surgeries.

Ruptured Appendix in Children and Adults

As appendicitis progresses, the organ can swell to the point that it rupures (bursts open). This can occur as soon as 24 to 72 hours after the condition starts.

The appendix ruptures in up to 32% of people with appendicitis.

A ruptured appendix can lead to a condition called peritonitis—inflammation of the lining of your abdomen. Peritonitis can be fatal.

Interval Appendectomy

An interval appendectomy is a removal of the appendix that is delayed. There are a variety of reasons that appendectomy might be delayed, such as:

• Spontaneous recovery from appendicitis
• Successful treatment with antibiotics
• Delayed accurate diagnosis (such as young children who cannot describe their symptoms)
• The person experiencing the condition doesn't understand the severity of it
• Pregnancy
• Lack of medical resources

But Appendectomy May Be a Secondary Surgery

An appendectomy is sometimes performed when the appendix is still healthy, called a prophylactic appendectomy. This is usually done during surgery for other conditions that affect the abdomen or pelvis, such as endometriosis excision surgery.

Prophylactic appendectomy is controversial among healthcare providers. The procedure is performed to avoid appendicitis from occurring in the future. However, there are additional risks, such as increased time under anesthesia and increased risk of infection.

Risks and Complications

As with any procedure, some potential risks and complications can occur with appendectomy. These can include:

• Abscesses
• Infection
• Blockage in the intestines
• Hernia
• Pneumonia
• Bleeding
• Urinary tract infection (UTI)
• Heart attack
• Death
• Premature labor in pregnant women

Recovery Time After Appendectomy

Recovery time after appendectomy depends on the type of surgery you have. Laparoscopic appendectomy is sometimes performed as an outpatient procedure, while open surgery can require a short hospital stay.

Pain Inside Incision

During a laparoscopic appendectomy, gas is pumped into the belly to allow the surgeon to see your internal organs with a camera. This can cause pain for several days after surgery until your body can get rid of the gas. Additionally, you may have soreness at your incision sites.

Open appendectomy requires the surgeon to cut through your abdominal muscles to get to your appendix. As a result, you might have pain for several weeks after the procedure. Holding a pillow against your abdomen when you stand up, cough, or sneeze, can help reduce the severity of this pain while the muscles are healing.

Residual Scar and Scar Tissue

Scar tissue forms after any surgery as part of the normal healing process. Laparoscopic appendectomy causes less scar tissue than an open procedure.

After an appendectomy, scars can appear red for four to six weeks but usually fade after several months. In some cases, you might not be able to see them anymore—especially if you've had laparoscopic surgery.

Summary

Appendectomy is used to treat appendicitis. It is often done as an emergency procedure—if the appendix bursts, it can be fatal. Appendectomy is usually done laparoscopically, with several tiny incisions that allow for the insertion of tools. However, an open procedure with a longer incision is required in some cases.

Laparoscopic appendectomy can sometimes be performed as an outpatient procedure, while open surgery might require a short hospital stay with longer recovery times.