Appendectomy

What is an appendectomy?

An appendectomy is surgery to remove the appendix. The appendix is a small finger-shaped pouch where the large and small intestines join. Scientists are not sure what the appendix does, if anything. Removing it does not appear to affect your health.

An appendectomy is usually an emergency operation done to prevent the serious health problems that can happen if the appendix ruptures.

When is it done?

An appendectomy is done when the appendix is infected or inflamed (appendicitis).

It is important to get treatment for appendicitis before the appendix ruptures. A rupture is a break or tear in the appendix. If an infected appendix ruptures, infection and bowel movement may spread inside the abdomen. This can cause peritonitis, which is a life-threatening infection of the belly. Peritonitis can be fatal if it is not treated right away.

If an abscess (a pocket of pus) has formed around a ruptured appendix, your provider may drain the abscess before surgery. To drain an abscess, you will be given a local anesthetic to numb your skin. Then your provider will put a drainage tube through the abdominal wall and into the abscess. You will have a special kind of X-ray called computed tomography, or CT, to help find the abscess. The drainage tube will be left in place for about 2 weeks while you take antibiotics to treat the infection. Six to 8 weeks later, when infection and inflammation are under control, surgery will be done to remove what is left of the ruptured appendix.

How do I prepare for an appendectomy?

Usually an appendectomy is an emergency procedure and there is no time to prepare.

If you do have time to prepare before the surgery:

• Find someone to drive you home after the surgery. Plan for your care and recovery after the operation. Allow for time to rest. Try to find people to help you with your day-to-day duties while you recover.
• Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery.
• Before your surgery, stop taking any blood thinning medicines you may have been taking. If you need a minor pain reliever before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. Aspirin, ibuprofen, or naproxen can cause extra bleeding during surgery.
• The night before the procedure, eat a light meal such as soup and salad. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.
• Follow any other instructions your provider gives you.

What happens during the procedure?

You will be given a general anesthetic. A general anesthetic will relax your muscles and put you to sleep. It will prevent you from feeling pain during the operation.

Your surgeon will perform either open surgery or laparoscopic surgery.

If you have open surgery (a laparotomy):

• Your surgeon will make a cut 2 to 3 inches long in your abdomen (belly).
• Your surgeon will find the appendix and remove it.

If you have laparoscopic surgery:

• Instead of a cut 2 to 3 inches long, the surgeon will make very small cuts in your belly.
• The surgeon will put a tiny camera and tools through the small cuts to find and remove the appendix.

Your surgeon will close cuts made in your abdomen with sutures (stitches).

If you have an abscess, the surgeon may put a drainage tube in your abdomen before or during surgery to let the infection drain from your body for a few days after surgery.

What happens after the procedure?

For the first day or so after surgery, you may not be given anything to eat or drink. Then you will be allowed to have small amounts of water, later clear liquids, and finally some solid food until you are able to have a regular diet.

You will stay in the hospital 1 to 3 days after the operation. In most cases you should be able to go back to your normal daily activities in 1 to 3 weeks. If your appendix ruptured or an abscess formed, you may need to stay at the hospital longer and it may take more time to recover.

If you have a drainage tube, it will be removed when the infection has cleared up.

The most important thing to do as you recover is to follow the full course of treatment ordered by your healthcare provider, including taking all of any prescribed antibiotics. To feel better as soon as possible you should also:

• Get plenty of sleep but avoid staying in bed for long periods of time during the day.
• Take pain medicine according to your provider's instructions.
• Eat foods high in protein while you are healing if your provider says it is OK.
• Eat small frequent meals.
• Keep the surgical cut(s) clean.
• Wash your hands before and after changing the dressing on the surgical cut(s).
• Gradually increase your walking and activity as directed by your provider.

Ask your healthcare provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

Having your appendix removed:

• Prevents spread of infection.
• Can stop your appendix from rupturing.
• Prevents formation of an abscess around your appendix.

The benefits of having laparoscopic surgery instead of open surgery are:

• You will have less pain after the surgery.
• There are usually fewer complications.
• You will recover from the operation faster.

What are the risks associated with this procedure?

Risks of this procedure include:

• There are some risks associated with general anesthesia. Discuss these risks with your healthcare provider.
• You may have infection or bleeding.
• The surgery may find that your appendix is normal and not inflamed. Healthcare providers cannot always be sure that the appendix is inflamed until it is examined during surgery. However, it is appropriate for a provider to risk removal of a normal appendix so that he or she is sure to not miss a case of true appendicitis. An advantage of this is that it will eliminate the future possibility of appendicitis.

When should I call my healthcare provider?

Call your provider right away if:

• You develop signs of infection around your surgical wound. These include:
  • The area around the wound is getting redder or more painful.
  • You have red streaks from the wound going toward your heart.
  • The wound area gets very warm to touch.
  • You have blood, pus, or other fluid coming from the wound area.
  • You have a fever higher than 101.5° F (38.6° C).
  • You have chills, nausea, vomiting, or muscle aches.
• You have vomiting that doesn't stop.
• You are dizzy or felling like you are going to faint.
• You have more pain in your belly.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.