Appendectomy

Overview

Appendectomy is the surgical procedure to remove the appendix. This is the most common course of treatment for appendicitis (inflammation of the appendix). An appendectomy is a crucial surgical procedure that is performed immediately to prevent the potentially life-threatening effects of appendicitis. There are two types of appendectomy procedures: open and laparoscopic. The choice between these methods is determined by the healthcare provider based on what is deemed most suitable for the patient.

The appendix is a small pouch that joins the big intestine. It is positioned in the abdomen’s lower right quadrant. An appendix should be removed immediately if a patient has appendicitis. Their appendix has the potential to burst and provide a serious health risk if left untreated.

Types

The appendix can be removed surgically in two different ways. An open appendectomy is the standard procedure. Laparoscopic appendectomy is a less invasive, more recent technique.

• Open appendectomy:The lower right side of the abdomen has a cut or incision that is between two and four inches long. The incision is used to remove the appendix.
• Laparoscopic appendectomy: This approach is a minimally invasive procedure. This indicates that there isn’t a big incision made. Rather, one to three microscopic incisions are created. One of the incisions is used to insert a laparoscope, which is a long, thin tube. It features surgical instruments and a tiny video camera. To guide the instruments and see within the abdomen, the surgeon looks at a TV monitor. One of the incisions is used to remove the appendix.

During laparoscopic surgery, the surgeon may decide on an open appendectomy, particularly if your appendix has ruptured and infection has spread. While a laparoscopic appendectomy typically entails less pain and scarring compared to the open procedure, the resulting scar from either method is often inconspicuous once healed. Both surgeries pose low risks of complications, but a laparoscopic appendectomy is associated with a shorter hospital stay, quicker recovery, and lower infection rates. Recent studies have proposed the potential efficacy of treating appendicitis solely with intravenous antibiotics, challenging the necessity of appendectomy; however, these findings are contentious, and currently, appendectomy remains the established standard of care.

Reasons for undergoing the procedure

Appendicitis is considered a medical emergency due to the rapid swelling of the appendix, a small organ that can quickly lead to inflammation and subsequent rupture. The swelling can occur swiftly, with a burst appendix posing the risk of spreading infectious agents throughout the abdominal cavity, causing peritonitis. If the infection extends to the bloodstream, it may result in sepsis, a potentially life-threatening systemic condition. Time is critical, as the appendix can rupture within 36 hours of the initial symptoms, making prompt treatment essential. While appendectomy (surgical removal of the appendix) is typically the safest approach, there are exceptions, such as cases where surgery is not feasible. In some instances, early and uncomplicated appendicitis may respond to antibiotics alone, though this poses a risk of recurrent appendicitis. Despite the low risks associated with surgery, the greater danger lies in the potential for appendix rupture, emphasizing the urgency of intervention.

Risk

Following an appendectomy, some potential risk include:

• Bleeding.
• Wound infection.
• Peritonitis is the term for the infection, redness, and swelling (inflammation) of the abdomen that can result from an appendix rupture during surgery.
• Injury to nearby organs.
• Bowels that are blocked.

Before the procedure

Prepare for surgery by understanding the procedure, signing a consent form, and providing your medical history. Your healthcare provider will conduct a physical exam and may request blood tests. Refrain from eating or drinking for 8 hours before the surgery. Ensure your provider has a list of all medications, including over-the-counter drugs and supplements. If necessary, a sedative may be administered before the procedure. Inform your healthcare provider of pregnancy, latex allergies, or any bleeding disorders. Appendectomies are typically scheduled within 24 hours for acute appendicitis. Antibiotic treatment will begin through an IV line, and additional diagnostic tests may be performed based on your condition. Surgery consent and pre-surgery instructions will be discussed by your healthcare team.

During the procedure

The patient will be taken to the operating room after taking off all jewelry and changing into a hospital gown. To induce a deep sleep, they will be given a general anesthesia while lying on their back. In order to avoid muscle spasms, they will also be administered a muscle relaxant.

They will have a tiny tube inserted through their mouth down their throat to keep their airway open and to keep an eye on their breathing. During the procedure, the anesthesiologist will keep a close eye on their vital signs.

• Open appendectomy: During an open appendectomy, a larger incision is made in the lower right abdomen, allowing the surgeon to access the abdominal cavity. The abdominal muscles are then separated to locate the appendix, and if there is a rupture, any abscess or fluid in the abdominal cavity is drained before proceeding with the appendectomy. The abdominal cavity is rinsed with a saline solution. In both open and laparoscopic procedures, the appendix is secured with stitches, detached from the intestine, and removed, with excess fluids and gas drained through the incisions. If peritonitis is present, a drainage tube may be left in the abdomen for ongoing fluid drainage. Subsequently, the breathing tube is removed, and incisions are closed with stitches, cleaned, and dressed. After the surgery, you will be transferred to a recovery room until consciousness is regained.
• Laparoscopic appendectomy: In a laparoscopic appendectomy, the surgeon begins by making a small incision near the belly button. Through this incision, a tiny port is inserted, and a cannula follows to inflate the abdominal cavity with carbon dioxide gas, providing more space for the operation and improving visibility in photographic images. Subsequently, the cannula is exchanged for a laparoscope—a slender tube with a light and high-resolution camera. The surgical procedure is projected onto a video screen, enabling the surgeon to pinpoint the appendix and guide instruments through one to three small incisions. Occasionally, unexpected complications may arise, detected by the laparoscope, potentially leading to a conversion to open surgery for appropriate management.

After the procedure

After an uncomplicated laparoscopic appendectomy, there is a possibility of being discharged on the same day, but it is essential to arrange for someone else to drive you home while the effects of anesthesia wear off. In the case of a ruptured appendix or open surgery, a longer hospital stay may be necessary, typically lasting a few more days. Throughout this period, you will receive intravenous antibiotics, and your healthcare team will closely monitor your condition. The removal of the drainage tube may still be required as part of the ongoing postoperative care.

Outcome

The time required for recovery after an appendectomy depends on various factors, including the severity of the appendicitis, the extent of the surgical procedure, and the body’s response to the surgery. Typically, pain and side effects should noticeably diminish within a few days, but returning to regular activities may take several days to weeks. Most individuals achieve complete recovery in six weeks or less.

Patients are advised to maintain the cleanliness and dryness of the surgical wound at home, following bathing instructions provided by their healthcare provider. Stitches or surgical staples, if used, will be removed during a follow-up visit. If adhesive strips were applied, it’s best to keep them dry as they usually vanish within a few days.[Text Wrapping Break]

Sometimes, there may be discomfort in the abdominal muscles and the incision area, particularly after prolonged periods of standing. Patients should only take pain relievers as directed by their healthcare provider to alleviate this discomfort. It’s important to note that bleeding may occur more frequently if aspirin or other painkillers are taken. Therefore, medications should only be administered according to the healthcare provider’s instructions. [Text Wrapping Break]

After surgery, patients should generally make an appointment for a follow-up visit with their healthcare provider two or three weeks later. However, they should seek immediate medical attention if they have the following:

• Fever or chills.
• Redness or swelling at the incision site.
• Severe pain around the incision site.
• Drainage from the incision site.
• Difficulty in breathing.
• Stomach cramps.
• Loss of appetite or unable to eat and drink.
• Constipation or no bowel movement for 2 days or more.
• Diarrhea for more than 3 days