Appendectomy
Appendectomy
by Rosalyn Carson–DeWitt, MD
Anatomy and Physiology
The appendix is a small, hollow, finger–like projection attached to the large intestine in the right lower abdomen, near where the large and small intestines are joined. It is not known what function the appendix has, if any.
 Normally there is an opening between the appendix and large intestine, which allows fluid and other materials to flow freely in and out of the appendix.
Reasons for Procedure
 When the opening between the appendix and the intestine becomes blocked, there is a buildup of secretions and gas. If the swollen, infected appendix is not surgically removed, it can rupture, resulting in peritonitis, a life–threatening infection of the abdominal cavity.
One symptom of appendicitis is abdominal pain. The pain usually: starts around the area of the belly button, moves to the right lower area of the abdomen, becomes increasingly severe over 12–24 hours, and worsens with movement.
Other symptoms of appendicitis include: loss of appetite, nausea and vomiting, diarrhea or constipation, fever and chills.
Treatments
An appendectomy is the only treatment for appendicitis. There are two types of operations used to remove the appendix: a traditional open procedure and a laparoscopic procedure. A laparoscopic appendectomy involves small “keyhole” incisions, is generally less painful, and requires a shorter recovery time than the traditional, open approach.
Procedure
An appendectomy is most often performed on an emergency basis, so it usually requires general anesthesia, which will put you to sleep for the duration of the procedure. After you are asleep, a breathing tube will be inserted into your mouth and windpipe to help you breathe during the operation.
 In an uncomplicated appendectomy, your surgeon will make the type of incision necessary for the chosen procedure: a single larger incision for a traditional open appendectomy, or several tiny keyhole incisions for a laparoscopic appendectomy. Locations of these incisions will vary depending on the preferences of your surgeon.
In laparoscopic appendectomy, your surgeon will use a tool called a trocar to create an opening or keyhole near your navel. Carbon dioxide gas will be pumped through this port to puff up your abdomen so its contents can be viewed more easily. Your surgeon will create other openings through which surgical instruments may be passed.
Next, your surgeon will insert the laparoscope through the first opening. Images from its camera will be projected onto a video monitor in the operating room.
The basic method of removing the appendix is the same for both traditional and laparoscopic appendectomies. Your surgeon will tie off blood vessels in the area to prevent bleeding. He or she will then use surgical instruments to grasp the appendix, isolate it from its surroundings, separate it from the intestine, and remove it from the abdomen.
At the end of the procedure, the traditional or keyhole incisions will be closed with sutures and dressed with bandages.
If the appendix has ruptured, your surgeon will use large amounts of warm, sterile salt solution to rinse out the abdominal cavity. A drain will often be left in place to allow fluid to escape and you will be given antibiotics through an IV.
In this case, your surgeon may leave the incision open to heal on its own over 5–10 days. Your recovery period will be substantially longer than for an uncomplicated appendectomy.
Risks and Benefits
Possible complications of appendectomy include: wound infection, peritonitis, which is an infection inside the abdomen, abscess inside the abdomen or pelvis, delayed bowel function, excessive bleeding, side effects from anesthesia, rarely, injury to the healthy intestines nearby.
Benefits of appendectomy include: removal of an inflamed appendix that may otherwise burst and lead to a life–threatening case of peritonitis, no risk of appendicitis in the future.
In an appendectomy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it’s the most appropriate treatment for you.
After the Procedure
You may be able to leave the hospital the same day as your surgery, especially if you have had an uncomplicated laparoscopic appendectomy. However, if you have had traditional open appendectomy or if your appendix has burst, you may need to stay in the hospital for several days.
You may be given antibiotics to help fight infection, particularly if your appendix has already burst. Any drainage tubes left in place will usually be removed within a few days of your surgery.
After an uncomplicated appendectomy, your surgeon will usually advise you to: get up and walk around the day of the surgery; keep the incision clean and dry; avoid lifting; avoid constipation and straining during bowel movements by drinking plenty of fluids and eating high–fiber foods such as fruits, vegetables, beans, and whole grains; move your bowels as soon as you feel the urge. The same advice often applies in the case of a ruptured appendix, but over a longer time
period.
Be sure to call your doctor immediately if you notice: signs of infection, such as fever and chills, redness, swelling, increased pain, excessive bleeding, or discharge from the incision sites, difficulty urinating, nausea or vomiting, constipation, pain that isn’t relieved by available medication, cough, shortness of breath, or chest pain.
Sources
Appendicitis. Mayo Clinic Website. Available at: http://www.mayoclinic.com/invoke.cfm?id=DS00274. Accessed February 6. 2004.
Appendicitis. National Digestive Diseases Information Clearinghouse. Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/appendicitis/index.htm. Accessed February 6, 2004.
Appendicitis. Sabiston Textbook of Surgery, 16th edition. Philadelphia: W.B. Saunders
Company; 2001: 918–928.
When You Need an Operation: About Appendectomy, American College of Surgeons. Available at: http://www.facs.org/public_info/operation/app.pdf. Accessed February 6, 2004.
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