Appendectomy: Indications and Risks

Appendix is a small tubular pouch attached to the beginning of the large intestine. Inflammation of the appendix leads to appendicitis the symptoms of which are:

• Pain around the navel which shifts towards lower right side of the abdomen with time
• Nausea
• Vomiting
• Loss of appetite
• Swelling of the abdomen
• Fever
• Increased rigidity of the abdominal wall

Most doctors treat appendicitis with appendectomy, a surgery that removes the appendix. This surgery can be performed in two ways:

• Laparoscopic surgery: the surgeon makes several small incisions in the abdominal wall through which special tools are inserted to remove the appendix
• Laparotomy: by making an incision in the lower right abdomen the surgeon opens the abdominal cavity to remove the appendix.

Procedure

The surgery for appendicitis is done under general anaesthesia. After the effects of anaesthesia set in your surgeon will make an incision depending upon the type of surgery.

Laparoscopic surgery:  your surgeon will make 5-6 mm incisions on your abdomen to insert specialised instruments into your abdomen. Using a thin tube called a cannula carbon dioxide will be introduced into your abdominal cavity to inflate it a little for better visualisation. This procedure can be used only if the appendix is intact, in case of a ruptured appendix a Laparotomy has to be performed.

Laparotomy: your surgeon will make an incision in the lower right abdomen to gain access to your appendix. In case of a ruptured appendix the contents of the appendix spread into the abdominal cavity causing peritonitis. Your surgeon will clean the abdominal cavity and subsequently remove the appendix. The incision will be closed with the help of absorbable sutures.

Indications for Appendectomy

Appendectomy is the standard form of treatment for appendicitis. Laparoscopic surgery is preferred unless there is a contraindication, like in the case of a perforated appendix where a laparotomy is required.

Preparation

Most of the appendectomies are emergency operations hence there isn’t much time for preparation. The patient is asked to not eat or drink before the surgery. If it is a planned surgery your doctor would like to know about all the medications you’ve been taking and might ask you to stop some of them like blood thinners and over-the-counter pain relief medications. You might also be asked to stop eating and drinking the night before the surgery. your doctor would also like to know about any allergies to anaesthetics that  you might have.

Risks of Appendectomy

Appendectomy is a fairly simple and common procedure. The risks associated with it are:

• Infection
• Blockage of bowel
• Injury to nearby organ
• Bleeding during surgery

Recovery

The amount of time that you might have to spend in the hospital after the surgery depends on the type of surgery and the anaesthetic medication used. It is advisable to arrange for someone to drive you home after discharge from the hospital. You might feel slight pain at the site of the surgery, inform your doctor about it; the doctor will prescribe medication to control the pain. Full recovery from the surgery takes about four weeks; you are advised to restrict your activities till then. If you notice any of the following signs immediately contact your doctor:

• Fever
• Redness at the sight of surgery
• Constipation or diarrhea for more than two days
• Vomiting
• Abdominal cramps.

Resources:

• National Institute of Diabetes and Digestive and Kidney Diseases
• Society of American Gastrointestinal and Endoscopic Surgeons