Appendectomy Surgery: Everything You Need to Know

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An appendectomy is a fairly straightforward surgical procedure to remove an inflamed or infected appendix, a condition known as appendicitis. Without surgery, the appendix can rupture, spilling infectious material into the bloodstream and abdomen, which can be life-threatening. The appendix, a small, tube-like organ attached to the top of the large intestine, has no known purpose, so its removal is of little concern long term.

How to Relieve Gas After a Laparoscopic Appendectomy
 Verywell / Jessica Olah

What Is an Appendectomy?

Appendicitis occurs when a blockage forms inside the appendix leading to increased pressure, altered blood flow, and inflammation. An appendectomy is typically performed as an emergency procedure to remove the appendix before it bursts and spreads infection into the lower abdomen, which can cause peritonitis. 

The primary symptom of appendicitis is severe pain in the abdomen, typically on the lower right side. Pain onset is sudden and worsens over time. Some people may or may not also experience other symptoms of appendicitis including:

  • Abdominal swelling 
  • Loss of appetite
  • Nausea and vomiting
  • Constipation or diarrhea
  • Inability to pass gas
  • Low fever

An appendectomy is almost always required to treat appendicitis. The surgery can be performed laparoscopically (most common) or as an open procedure and may require a short hospital stay for recovery. 

Contraindications

There are no contraindications for an appendectomy itself, but the laparoscopic (minimally invasive) technique may not be advised for certain individuals.

In some cases, open surgery may be preferred from the start, or a decision is made during a laparoscopic appendectomy to change to open surgery.

Patients who are more at risk for this include those with: 

  • An extensive infection or abscess
  • A perforated appendix
  • A history of prior abdominal surgery with scar tissue
  • Excessive abdominal fat hindering organ visibility
  • Bleeding problems during the operation 

According to guidelines by the Society of American Gastrointestinal and Endoscopic Surgeons, laparoscopic procedures are considered safe for all patients including children, the elderly, those who are obese, and pregnant women during all trimesters. It can even be used in the case of a ruptured or perforated appendix.

Potential Risks

The general risks of any surgery, including infection and reaction to anesthesia, apply here.

Given the nature of an appendectomy, the procedure also poses a risk of:

  • A leak at the edge of the colon
  • Injury to adjacent organs such as the small intestine, ureter, or bladder

Contact your surgeon immediately if you experience abdominal pain, fever, chills, or rectal bleeding. 

Purpose of an Appendectomy

Roughly one in 2,000 people will have their appendix removed in their lifetime, most commonly between the ages of 10 and 30. Since the appendix doesn’t appear to serve any purpose and the risks from a ruptured appendix exceed those from surgery, appendectomy is the first-line treatment for appendicitis. 

Appendicitis is diagnosed based on the patient's condition, blood tests, and a computed tomography (CT) scan. Once confirmed, the time from diagnosis to surgery can be brief—especially in the case of a ruptured appendix. Or if you are stable with pain control, surgery could occur a few hours later.

What to Expect on the Day of Surgery

Prior to having an appendectomy, your surgeon will explain the surgery in detail, including a description of the procedure, the risks of surgery, and what a typical recovery looks like. You will likely be asked to sign consent forms at this time as well.

Before the Surgery

Patients with appendicitis are typically admitted to the hospital through the emergency room after presenting with severe abdominal pain.

Prior to surgery, you will change into a hospital gown and be connected to an IV. Fluids and medication to manage nausea, vomiting, and pain will be given through the IV.

Antibiotics are almost always given prophylactically prior to surgery. Patients treated with antibiotics are less likely to develop peritonitis, have lower pain scores, a lower rate of perforation, and are able to return to work sooner. Those patients who need emergency surgery also receive prophylactic antibiotics within a 60-minute window before the initial incision.

You will be transported to the operating room and assisted onto the operating table, where the staff will swab the surgical site with a solution that kills germs to help prevent infections along the incision. Once your skin is prepared, the staff will cover you with sterile drapes to keep the area as clean as possible during the procedure.

The anesthesia provider will give you an IV sedative to help you relax. Then a breathing tube, or endotracheal tube, is threaded through the mouth and into the windpipe before being connected to the ventilator.

The breathing tube is necessary because general anesthesia causes temporary paralysis in addition to rendering you unconscious. While sedated, you cannot breathe without assistance and will depend upon the ventilator to supply air to the lungs.

During the Procedure

Once the anesthesia has taken full effect, the surgeon can begin making the incision. You will feel no pain and will not wake. The anesthesiologist will closely monitor your vital signs throughout the surgery and deliver medications as needed.

During an appendectomy, the surgeon makes an incision, finds the appendix, and cuts it away from the intestine and surrounding tissue. They then remove the infected organ.

Laparoscopic Step-by-Step

A laparoscopic appendectomy involves three incisions: one half-inch incision in the belly button and two 5-millimeter (mm) incisions in the left lower abdomen. The surgeon inserts a tiny camera and surgical instruments through the holes, then watches the video monitor as they work.

Carbon dioxide gas is used to swell the abdomen so the appendix and other organs can be easily identified. The surgeon finds the appendix, stitches it off and cuts out the infected organ, which is placed in a sterile bag that is pushed through one of the incisions before being removed. This is to prevent any pus or infectious material inside the appendix from leaking into the abdomen.

The remaining tissue is then closely inspected to make sure that only healthy tissue is left behind and ensure that the suture/staple line is perfect. If necessary, such as in the event of a ruptured appendix, the surgeon may use sterile saline to wash the area and then suction out the infectious material.

The surgeon then closes the incisions, typically with small sticky bandages called Steri-Strips or a sterile bandage to protect the skin and prevent infection.

The entire procedure usually lasts 45 minutes to an hour. However, if complications arise, the procedure can take longer (for example, if a laparoscopic procedure must be converted into an open procedure).

Open Surgery Step-by-Step

During an open appendectomy, a 2- to 4-inch incision is made in the lower abdomen. The abdominal muscles are separated and the abdominal area opened.

The surgeon then ties off the appendix with stitches and cuts off the infected tissue. If the appendix has burst or ruptured, the abdomen will be washed out with saline.

The abdominal lining and muscles are then closed with stitches. A small tube may be put in the incision to drain out fluids. The incision will be covered with a sterile bandage to protect the skin and prevent infection.

The procedure, from the initiation of anesthesia to bandaging, takes less than an hour if there are no complications.

After the Surgery

Once the incision is covered, the anesthesia is stopped and you will slowly begin to wake. As the anesthesia wears off, the breathing tube is removed, upon which time you'll move to the Post-Anesthesia Care Unit (PACU) for monitoring.

You can expect to be groggy at first, slowly become more alert. Your vital signs will be monitored closely for any possible complications and pain medication given when necessary.

Once you are awake and your blood pressure, pulse, and breathing are stable you will be moved to a hospital room to begin healing.

Recovery

Your recovery process begins at the hospital. Discharge will depend on the type of procedure you had and your overall health. Most patients have a notable decrease in pain after surgery, even with the pain of the incision.

Follow all of your doctor's instructions for wound care, bathing, and resuming normal activity and exercise. And don't forget to make a follow-up appointment for two to three weeks after your appendectomy, or as otherwise advised by your physician.

Healing After Laparoscopy

Laparoscopy is a less-invasive procedure than the open appendectomy and, therefore, recovery is faster and easier. In some cases, you may even be discharged straight from the recovery room.

You will be allowed to drink clear liquids within a few hours of the procedure and, if tolerated, begin eating solid foods. You will also be encouraged to get up and walk a few hours after laparoscopic surgery. Once you reach these milestones, you will discharged with instructions on how to care for your incisions.

For the first few days after a laparoscopic appendectomy, you may experience abdominal pain from the carbon dioxide gas still in your belly. Sipping warm water with lemon or peppermint tea can help relieve the gas, as can moving your legs and torso around (e.g., by walking a bit). Movement encourages peristalsis in the bowels, which helps release trapped gas.

Healing After Open Surgery

An open surgical procedure will take longer to recover from and you may be in the hospital for a few days. You will be connected to an IV for fluids and medication for at least the first night.

A thin plastic tube that goes through your nose into your stomach may be used to remove stomach fluids and air that you swallow. It will be removed when your bowels are working normally.

You will not be able to eat or drink until the tube is removed. At that point you will be allowed to start with small sips of clear fluid. If tolerated, you will progress to soft foods and, finally, a regular diet.

You will be encouraged to get up and walk the morning after surgery and continue getting out of bed several times each day before you are discharged. You may require pain medication for getting out of bed at first because your abdominal muscles have been cut and will take time to heal.

Pain Management

Upon leaving the hospital, you will be given instructions on how to manage your pain and possibly a prescription for opioid pain killers, such as OxyContin (oxycodone) or Percocet (oxycodone with acetaminophen).

While opioids are very effective pain relievers, they are addictive and should only be when necessary. Opioid side effects can also be significant and include nausea, vomiting, constipation, urinary retention, drowsiness, impaired thinking skills, and poor respiratory function.

Over-the-counter non-steroidal anti-inflammatory drugs like Tylenol (acetaminophen) and Advil (ibuprofen) can also be used to treat post-surgical pain. For many, these are sufficient. Many doctors recommend alternating dosing between the two.

Note: Percocet also contains acetaminophen and should not be taken with Tylenol as liver damage can occur.

Wound Care

Your doctor will provide instructions on caring for your incision (keeping it clean and dry) and bathing.

If your incisions are being held closed with Steri-Strips, be sure to also keep them dry until they fall off (typically within a few days) or are removed by your doctor. If you got stitches, they will be removed at your follow-up appointment.

When To Call Your Doctor

Regardless of the type of appendectomy you had, your doctor will advise you to watch out for signs of infection and other problems. Call your doctor if you experience any of the following:

  • Fever or chills
  • Redness, swelling, bleeding, or drainage from the incision site
  • Increasing pain around the incision site after the third day
  • Vomiting
  • Loss of appetite or unable to drink or eat
  • Difficulty breathing, constant coughing, or shortness of breath
  • Abdominal pain, cramping, or swelling
  • No bowel movement for two or more days
  • Watery diarrhea for more than three days

Resuming Activity

You will need to take it easy for the first few days after your surgery. Most patients may be able to resume normal activities after about a week (or sooner with laparoscopic surgery), but will be advised to refrain from strenuous activity and exercise for a week or more. Follow all of your doctor's instructions.

A Word From Verywell

An appendectomy is one of the most common emergency procedures, with more than 250,000 performed in the United States each year. Research shows both open and laparoscopic appendectomies have low rates of long-term surgical complications. As long as you follow your doctor's instructions to take it slow and ease into strenuous activity, odds are good you will make a full recovery and be back to your old activities soon.

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