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

The Society of American Gastrointestinal and Endoscopic Surgeons considers laparoscopic procedures considered safe for everyone, including:

  • Children
  • The elderly
  • The obese
  • Pregnant women during all trimesters

It can even be used when the appendix is ruptured or perforated.

While there are no contraindications for an appendectomy itself, the laparoscopic (minimally invasive) technique isn't right for everyone.

In some cases, open surgery (with a larger incision) may be preferred from the start, or the surgeon may decide during laparoscopy to change to open surgery.

You're more likely to need open surgery if you have: 

  • An extensive infection or abscess
  • A perforated appendix
  • Scar tissue from prior abdominal surgery
  • Excessive abdominal fat that hinders organ visibility
  • Bleeding problems during surgery 

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 after you leave the hospital. 

Purpose of an Appendectomy

Roughly one in 2,000 people 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:

Once confirmed, the time from diagnosis to surgery can be brief—especially in the case of a ruptured appendix. If you're stable with pain control, surgery could occur a few hours later.

What to Expect on the Day of Surgery

Before your appendectomy, your surgeon should explain the surgery in detail, including:

  • A description of the procedure
  • The risks of surgery
  • What a typical recovery involves

You may be asked to sign consent forms at this time as well.

Before the Surgery

Most people with appendicitis start out at the emergency room with severe abdominal pain and then are admitted before surgery.

Prior to surgery, you'll change into a hospital gown. A nurse or tech will place an IV, probably in your hand. You'll get fluids and medication to manage nausea, vomiting, and pain through the IV.

You'll probably be given antibiotics as a preventive measure. It can:

  • Lower your risk of peritonitis
  • Lower your pain levels
  • Make perforation less likely

This may help you return to work and normal activities sooner.

Once you're prepped, you'll be taken 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.

Then 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 is in effect, the surgeon will make the incision. You shouldn't wake up or feel anything. The anesthesiologist will closely monitor your vital signs throughout the surgery and deliver medications as needed.

The surgeon then finds your appendix, cuts it away from the intestine and surrounding tissue, and removes it.

Laparoscopic Step-by-Step

A laparoscopic appendectomy involves three incisions:

  • One half-inch incision in the belly button
  • Two 5-millimeter (mm) incisions in the left lower abdomen

The surgeon inserts a tiny camera and surgical instruments through the holes, using the video to guide them.

Carbon dioxide gas is used to swell the abdomen so the appendix and other organs can be easily identified. The surgeon finds the appendix, then stitches it off and cuts out the infected organ.

Before they remove it, the appendix is put in a sterile bag that's pushed through one of the incisions. That's to prevent any pus or infectious material inside the appendix from leaking into the abdomen.

The remaining tissue is then inspected to make sure only healthy tissue is left behind and ensure the suture/staple line is perfect.

If necessary, like if the appendix ruptures, 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 should be allowed to drink clear liquids within a few hours of the procedure and, if tolerated, begin eating solid foods.

You'll also be encouraged to get up and walk a few hours after laparoscopic surgery. Once you reach these milestones, you'll be 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'll 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 won't be able to eat or drink until the tube is removed. At that point, you can start with small sips of clear fluid. If that goes well, you'll progress to soft foods and, finally, a regular diet.

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

Pain Management

Upon leaving the hospital, you'll get instructions on how to manage your pain and possibly a prescription for opioid painkillers, such as OxyContin (oxycodone) or Percocet (oxycodone with acetaminophen).

While opioids are very effective pain relievers, they're 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
  • 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 between the two.

Note: Percocet also contains acetaminophen and should not be taken with other sources of acetaminophen (such as 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 inability 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'll need to take it easy a few days after surgery. Most people can resume normal activities after about a week (or sooner with laparoscopic surgery), but you'll 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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Article Sources
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