What Is An Appendectomy?

Introduction

An appendectomy (or appendicectomy) is a surgical procedure to remove the appendix. It is usually carried out as an emergency to manage appendicitis, which is inflammation of the appendix. It used to be thought that the appendix has no essential function in the human body, but research now suggests that it plays a role in gut health and the immune system.¹ However, removing the appendix is not harmful. 

Where is the appendix?

This small narrow organ, attached to the large intestine, is located in the lower right-hand side of the abdomen. It is 5-10 cm long and the most common problem that affects it is appendicitis.

What is appendicitis?

Appendicitis is inflammation of the appendix. Anyone can get appendicitis, but it is most common in people aged between 10 and 30 years. The cause of appendicitis can sometimes be unclear;² possible causes include:

• swelling around the appendix due to infection of the digestive tract or other areas of the body
• faeces (stools) causing irritation of the appendix 
• cancerous growths or tumours causing blockages at the opening of the appendix 
• inflammatory bowel disease

Signs and symptoms of appendicitis

The pain from the inflamed appendix can be felt as a general ache around the belly button or the centre of the abdomen.³ As the inflammation gets worse, the appendix can irritate the surrounding tissues and cause more severe, sharp pain that is felt in the lower right-hand area of the abdomen where the appendix usually lies. The pain can come and go and become constant as it gets more severe. The pain can be worse when taking deep breaths, moving around, coughing or sneezing. 

Other symptoms include:

• feeling sick or vomiting
• constipation or diarrhoea
• loss of appetite
• high temperature
• swelling or bloating of the abdomen

Inflammation of the appendix can cause it to swell which increases the pressure inside - this can reduce blood flow to the appendix, causing pain and damage to the tissues. If the inflammation continues to worsen and the appendix is not removed, it can burst (rupture). This can spread the inflammation to surrounding structures in the abdomen causing a life-threatening infection called peritonitis.

Diagnosis

A medical professional will ask detailed questions about the person’s symptoms and examine their abdomen to make an initial diagnosis. The pain from appendicitis can get worse when the lower right-hand side of the abdomen is pressed. 

To rule out other conditions, further investigations can be done, which may include:⁴ 

• urine tests
• blood tests
• ultrasound scan
• CT scan
• pregnancy test

Treatment

The treatment for appendicitis is usually antibiotics and surgical removal of the appendix. Appendectomy is one of the most common operations performed in the UK and has an excellent success rate.

Laparoscopic appendectomy

Laparoscopic appendectomy, also known as keyhole surgery, is less invasive than open surgery and is usually the preferred option.⁵ A laparoscope is a thin tube attached to a light and a camera - this is able to display the image taken from inside your abdomen on a computer screen that the surgeon can see.

The procedure is carried out under general anaesthetic. Three or four small incisions are made into the abdomen and surgical tools are inserted. Carbon dioxide gas is used to inflate the abdomen which allows the surgeon to view the appendix and move the tools around. After the appendix is removed, the incisions will be closed with stitches and the appendix will be checked in a laboratory for signs of disease.

Laparoscopic appendectomy advantages include shorter recovery times, reduced pain and less scarring.

Open appendectomy

An open appendectomy involves making a larger incision directly over the surgical area. It is used if the appendix has already burst, or if there is a complication during the laparoscopic procedure and the surgeon needs a better view of the appendix to remove it safely. Sometimes, if the patient has had open abdominal surgery before, an open approach will be needed due to the tissues inside the abdomen being scarred and having adhesions which makes the laparoscopic approach difficult.⁶

Under general anaesthetic, a larger incision is made in the lower right-hand side of the abdomen. The appendix is removed and stitches are used to close the incision. The appendix will be sent to a laboratory to check for signs of disease.

Risks

Appendectomy is a common operation and serious or long-term complications are rare.⁷ However, as with all surgery, there are some risks, such as:

• wound infection
• scarring
• bleeding under the skin (haematoma)
• hernia
• abscess
• adverse reaction to anaesthetic
• injury to nearby organs
• bowel blockage

Recovery

After surgery, patients will be monitored for potential complications and pain medication will be provided. Patients will be encouraged to get out of bed and move around a few hours after their operation and a medical professional will suggest an eating and drinking plan.

Laparoscopic surgery can reduce the stay in hospital to less than 24 hours; however if there are any complications, or open surgery is performed, the time spent in hospital may be up to a week.⁸

Before discharge, information will be provided on how to take care of the incision site and keep it clean and dry. A follow-up appointment will be arranged for one to two weeks later, when any stitches will be removed and the healing of the wound checked.

The abdomen and incision site may be painful. After laparoscopy, the gas used can remain in the abdomen for up to a week and cause pain in the tip of the shoulder. Pain medicine should only be taken as directed by the healthcare provider as some medications may not be advisable. 

It is important to move around and walk for short periods of time but avoid strenuous activity until your healthcare provider has advised it is safe to return to normal activities. This may take longer after open surgery.

Constipation can occur after the surgery which should get better after a few days. Drinking plenty of fluids and eating a high-fibre diet should reduce this. Medications to treat constipation can be prescribed if needed. 

A healthcare provider should be contacted if there are any problems during recovery. The most common are signs of infection:

• Increased pain
• Increased swelling
• High temperature
• Wound is hot to touch
• Vomiting
• Discharge from the wound

Summary

Appendectomy, removal of the appendix, is a common procedure to treat appendicitis and has very good outcomes. Even though appendicitis is a common condition, it can be very serious so it is important that the symptoms are identified and treated quickly. New laparoscopic techniques have already improved the way that appendectomies are carried out and new research is still emerging to continue to improve the surgery.