Appendix Removal

Appendectomy

(Appendix Removal, Laparoscopic Appendectomy, Open Appendectomy)

Procedure Overview

An appendectomy is the surgical removal of the appendix, a tube about six inches long or less that branches off the large intestine. The procedure is performed to treat appendicitis, an inflammation of the appendix caused by infection.

Acute appendicitis is the most common condition of the abdomen to require emergency surgery. Because of the likelihood of the appendix rupturing and causing a severe, life-threatening infection, the usual recommendation is that the appendix be removed as soon as possible.

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Appendicitis occurs when the interior of the appendix becomes filled with something that causes it to swell, such as mucus, bacteria, foreign body, stool, or parasites. The appendix then becomes irritated and inflamed. Rupture (or perforation) occurs as holes develop in the walls of the appendix, allowing stool, mucus, and other substances to leak through and get inside the abdomen. An infection inside the abdomen known as peritonitis occurs when the appendix perforates.

Because of the risk of rupture, which may occur as soon as 48 to 72 hours after symptoms begin, appendicitis is considered an emergency and anyone with symptoms needs to see a physician immediately.

Appendicitis may cause pain in the abdomen which may be described as follows:

• May start in the area around the belly button, and move over to the lower right-hand side of the abdomen, but may also start in the lower right-hand side of the abdomen

• usually increases in severity as time passes

• May become more severe with moving, taking deep breaths, being touched, and coughing or sneezing

• May spread throughout the abdomen if the appendix ruptures

Other symptoms of appendicitis include, but are not limited to, nausea and vomiting, loss of appetite, fever and chills, constipation, diarrhea, inability to pass gas, and abdominal swelling.

The symptoms of appendicitis may resemble other medical conditions or problems. In addition, each individual may experience symptoms differently. Always consult your physician for a diagnosis.

It is important that persons with symptoms of appendicitis not take laxatives or enemas to relieve constipation, as these medications and procedures can cause the appendix to burst. In addition, pain medication should be avoided, as this can mask other symptoms.

The appendix may be removed in one of two ways:

• Open method: In this method, a two- to three-inch incision is made in the lower right-hand side of the abdomen. The surgeon locates the appendix and removes it through the incision.

• Laparoscopic method: This procedure uses several small incisions and three or more laparoscopes - small thin tubes with video cameras attached - to visualize the inside of the abdomen during the operation. The surgeon performs the surgery while looking at a TV monitor. The appendix is removed through one of the incisions.

During a laparoscopic appendectomy, your physician may decide that an open appendectomy is needed.

A laparoscopic appendectomy may cause less pain and scarring than an open appendectomy, although even for open appendectomy, the scar is often hard to see once it has healed.

Open and laparoscopic techniques are thought to be comparable in terms of low rates of complications. However, length of hospital stay, length of overall recovery, and infection rates are reportedly lower with laparoscopic appendectomy.

An appendectomy is performed to remove the appendix when appendicitis is strongly suspected. During other abdominal surgical procedures, the appendix may be removed as a precaution to prevent future inflammation or infection of the appendix.

There may be other reasons for your physician to recommend an appendectomy.

As with any surgical procedure, complications may occur. Some possible complications include, but are not limited to, the following:

• Wound infection

• Peritonitis - an inflammation of the abdomen that can occur if the appendix ruptures during surgery

• Bowel obstruction

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

• In addition to a complete medical history, your physician may perform a physical examination to ensure you are in good health before you undergo the procedure. You may also undergo blood tests and other diagnostic tests.

• You will be asked when you last had anything to eat or drink, as you should have an empty stomach before undergoing the procedure. You will be instructed to fast until the procedure.

• If you are pregnant or suspect that you are pregnant, you should notify your physician.

• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

• The area around the surgical site may be shaved.

• You may receive a sedative prior to the procedure to help you relax.

• Based upon your medical condition, your physician may request other specific preparation.

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In general, an appendectomy is performed as emergency surgery and may require a hospital stay. Procedures may vary depending on your condition and your physician's practices.

An appendectomy is generally performed while you are asleep under general anesthesia.

Generally, the appendectomy follows this process:

• You will be asked to remove any jewelry or other objects that may interfere with the procedure.

• You will be asked to remove clothing and be given a gown to wear.

• An intravenous (IV) line will be inserted in your arm or hand.

• You will be positioned on the operating table on your back.

• The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

• An incision will be made in the right lower portion of your abdomen.

• The abdominal muscles will be separated and the abdominal cavity will be opened.

• After the appendix has been located, it will be tied off with sutures and removed.

• If the appendix has ruptured, the abdomen will be thoroughly washed out with saline. A small tube may be placed in the incision to drain out fluids or pus.

• The lining of the abdominal cavity and the abdominal muscles will be closed with stitches. A small tube may be placed in the incision to drain out fluids.

• The skin over the surgical site will be cleansed with an antiseptic solution.

• A small incision will be made for insertion of the laparoscope. Additional incisions may be made so that other instruments can be used during the procedure.

• Carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that the appendix and other structures can be easily visualized.

• The laparoscope will be inserted and the appendix will be located.

• The appendix will be tied off with sutures and removed.

• When the procedure is completed, the laparoscope will be removed. A small tube may be placed in the incision to drain out fluids.

• The appendix will be sent to the lab for examination.

• The skin incision(s) will be closed with sutures or surgical staples.

• A sterile bandage/dressing will be applied.

After the procedure, you will be taken to the recovery room for observation. Your recovery process will vary depending upon the type of procedure performed and the type of anesthesia that is given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. As a laparoscopic appendectomy procedure may be performed on an outpatient basis, you may be discharged home from the recovery room.

You may receive pain medication as needed, either by a nurse or by administering it yourself through a device connected to your intravenous line.

You may have a thin plastic tube inserted through your nose into your stomach to remove gastric secretions and air that you swallow. The tube will be removed when your bowels resume normal function. You will not be able to eat or drink until the tube is removed.

You will be encouraged to get out of bed within a few hours after a laparoscopic procedure or by the next day after an open procedure.

Depending on your situation, you may be given liquids to drink a few hours after surgery. Your diet may be gradually advanced to more solid foods as tolerated.

Arrangements will be made for a follow-up visit with your physician, usually two to three weeks after the procedure.

Once you are home, it is important to keep the incision clean and dry. Your physician will give you specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

The incision and the abdominal muscles may ache, especially after long periods of standing. Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Walking and limited movement are generally encouraged, but strenuous activity should be avoided. Your physician will instruct you about when you can return to work and resume normal activities.

Notify your physician to report any of the following:

• Persistent fever over 101 degrees F (39 C) and/or chills

• Redness, swelling, or bleeding or other drainage from the incision site(s)

• Increased pain around the incision site(s)

• Loss of appetite and inability to eat or drink fluids

• Persistent coughing, difficulty breathing, or shortness of breath

• Abdominal pain, cramping, or swelling

• Failure to have a bowel movement after two days or longer

Following an appendectomy, your physician may give you additional or alternate instructions, depending on your particular situation.