What to Expect During a Laparoscopic Appendectomy

If appendicitis is caught early, the irritated appendix can be removed during an emergency surgery called an appendectomy. One type of surgery is a laparoscopic appendectomy, a minimally invasive surgery in which small incisions (cuts) are made in the skin of the abdomen to insert a camera and small surgical tools that are used to remove the appendix.

This article discusses the laparoscopic appendectomy procedure, its potential risks, and how you can prepare for this kind of surgery.

Signs You Need Appendicitis Treatment

For many people, the first sign is pain near the belly button that may worsen as they move around, cough, or sneeze. The pain can be bad enough to wake you while sleeping and may worsen quickly.

However, because there are many potential causes of stomach pain, appendicitis can be hard to diagnose. Other symptoms may include:

• Fever
• Swollen or expanded stomach
• Not feeling hungry/loss of appetite
• Nausea
• Vomiting

If you have symptoms, see a healthcare provider. They will perform an examination, may recommend specialized tests, and will consider your overall condition to determine if you need appendicitis treatment.

Why Is Surgery Necessary?

Untreated appendicitis can be a life-threatening medical emergency. You can develop significant medical problems, including:

• Abscess (a sac of pus) 
• Ileus (loss of movement in the intestines)
• Peritonitis (inflammation of the internal lining of the abdominal cavity)
• Death

If undiagnosed or untreated, the appendix can become clogged, which creates pressure inside the small tube, cutting off the blood supply. The appendix can then tear or burst (rupture) and cause a life-threatening infection as stool (poop) from the intestines spreads into the belly.

Surgery to remove the irritated appendix can decrease the danger of serious complications from appendicitis. Delays in surgical removal of an inflamed appendix can increase the risk of sepsis.

Open Appendectomy vs. Laparoscopic Appendectomy

Your healthcare provider may offer different types of surgery. In general, you may have an open appendectomy (a type of laparotomy) or a laparoscopic appendectomy. 

During an open appendectomy, the surgeon makes a larger incision (about 2 inches long) in the belly. Some of the stomach muscles are separated for this surgery, and it is considered a more invasive surgery than the laparoscopic approach.

Laparoscopic Appendectomy

Laparoscopic appendectomies are becoming much more common and are considered the most effective surgical treatment for appendicitis.

Research shows that laparoscopic removal of the appendix has several advantages over open abdominal surgery, including:

• Less pain after surgery
• Lower rates of infection
• Less time in the hospital
• Quicker return to normal activity after surgery

Procedure

Laparoscopic appendectomy often requires making three small incisions (about one-half inch each) on the belly to allow the surgeon to insert a camera and small surgical instruments. The appendix is tied off and removed through one of the surgical incisions.

Risks

Your healthcare provider will review the general risks of surgery and the risks and benefits of laparoscopic removal of the appendix.  

Laparoscopic surgery is typically well-tolerated, and most people have positive outcomes. However, this approach is not right for everyone. Some common reasons for needing an open approach include:

• Having a badly inflamed or ruptured appendix
• Having obesity that creates a thick layer of fat under the skin
• Having scar tissue in the abdomen
• Bleeding too much
• The surgeon having difficulty seeing or finding the appendix using the laparoscopic technique

There is also some evidence that laparoscopic appendectomy increases the risk of an abscess forming inside the abdomen after surgery.

Considerations for Children

Laparoscopic appendectomy can be used to safely and effectively treat appendicitis in children. Laparoscopic approaches tend to have lower infection rates, and shorter hospital stays compared to open appendectomy.

Preparing for an Appendectomy

Because of the sudden onset of symptoms of appendicitis, treatment is often considered a medical emergency. You may not have much time to prepare. However, you should still be able to ask a healthcare provider questions about the plan and what to expect.

A healthcare provider may order blood tests and imaging studies, such as a CT (computed tomography) scan or X-ray, to diagnose appendicitis. Antibiotics are typically given just before surgery and may be continued after. You may also receive intravenous (IV) fluids and pain medication.

You will be asked to remove the clothing you arrived in and wear a hospital gown. Any hair in the area of surgery is typically removed, and the skin is cleaned to reduce bacteria.

What to Expect After Laparoscopic Appendectomy 

A healthcare provider or surgeon will discuss what to expect after surgery. Be sure to follow any instructions from your healthcare team. Your recovery will depend on how severe your appendicitis is, your body, your overall health, and the type of surgery or treatment you have.

First Few Days

After surgery, you may continue to receive IV fluids, pain medication, and antibiotics, depending on your medical condition. Incision sites tend to be sore for several days, and it may hurt to move, especially if you activate your abdominal muscles.

Due to the minimally invasive approach to surgery, you will typically be encouraged to be out of bed and start walking soon after surgery.

Your provider will determine when it is safe to resume drinking and eating again. You may need some time after surgery for your bowels to return to normal activity. Some people experience postoperative nausea and vomiting.

At-Home Recovery

Most people leave the hospital within one or two days of their laparoscopic appendectomy. Your provider may recommend resting and limiting activity for three to five days to allow your body to recover. Typically, most people can return to normal activities within a week.

Your provider may prescribe pain medications for you to take at home. Be sure you understand whether you have any driving restrictions while on those medications. Your surgeon will help you know when to resume eating and drinking and how to progress your diet.

Infection Risks

All surgery has some risk of infection. You can do the following to minimize your risk:

• Wash your hands.
• Take all the doses of prescribed antibiotics as directed.
• Follow any instructions you receive about how to care for your surgical incisions.
• Stop smoking.

When to Contact Your Healthcare Provider After Surgery

When you leave the hospital, you should receive discharge instructions about when to contact your healthcare provider after surgery. Keep an eye on your incision sites and report any signs of infection, including redness, warmth, swelling, or drainage. Inform your healthcare team immediately if you have a fever or chills, as well as unexpected bleeding. Most people's pain improves daily and is gone within a few days.

Summary

Appendicitis is a medical emergency often treated by removing the appendix during laparoscopic surgery. Belly pain is the most common symptom of appendicitis, but not all abdominal pain comes from it.

Be sure to seek medical care immediately if you have new or worsening stomach pain. Laparoscopic appendectomy is a minimally invasive procedure to remove the inflamed appendix and generally has fewer side effects than a conventional open appendectomy.