Appendicitis - Treatment 

Treating appendicitis 

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If you have appendicitis, your appendix will usually need to be removed as soon as possible. This operation is known as an appendectomy or appendicectomy.

Surgery will also usually be recommended if there is a chance you have appendicitis but it has not been possible to make a clear diagnosis. This is because it is considered safer to remove the appendix than run the risk of the appendix bursting.

In humans, the appendix does not perform any important function and having it removed does not cause any long-term problems.

The procedure

Appendectomies are carried out under general anaesthetic, using either a 'keyhole' or 'open' technique.

Keyhole surgery

Keyhole surgery (laparoscopy) is usually the preferred method of removing the appendix because the recovery tends to be quicker than with open surgery.

This operation involves making three or four small cuts in your abdomen (tummy). Special instruments are then inserted, including:

  • a tube through which gas is pumped to inflate your abdomen – this allows the surgeon to see your appendix more clearly and gives them more room to work
  • a laparoscope (a small tube containing a light source and a camera, which relays images of the inside of the abdomen to a television monitor)
  • small surgical tools used to remove the appendix

Once the appendix has been removed, the incisions will be closed with stitches that either dissolve over the next few days or need to be removed during an appointment at your GP surgery 7-10 days later.

Open surgery

In some circumstances, keyhole surgery isn't recommended and open surgery is performed instead. These include:

  • when the appendix has already burst and formed a lump called an appendix mass
  • when the surgeon is not very experienced in laparoscopic removal
  • people who have previously had open abdominal surgery

In these cases, the operation will involve making a single larger cut in the lower right hand side of your abdomen to remove the appendix. When there is widespread peritonitis (infection of the inner lining of the abdomen) it is sometimes necessary to operate through a long cut along the middle of the abdomen (a laparotomy).

As with keyhole surgery, the incision will be closed with stitches that either dissolve over the next few days or need to be removed at a later date. 

After both types of surgery, the removed appendix will routinely be sent to a laboratory to check there are no signs of cancer. This is done as a precautionary measure, although it is rare for a serious problem to be found.

Recovery

One of the main advantages of keyhole surgery is that the recovery time tends to be short and most people can leave hospital a few days after the operation. If the appendix is operated upon promptly then most patients can go home within 24hrs.

With open or complicated surgery (for example, if you have peritonitis), it may be a week before you're well enough to go home.

For the first few days after the operation you are likely to experience some pain and bruising. This will improve over time but you can take painkillers if necessary.

If you had keyhole surgery, you may experience pain in the tip of your shoulder for about a week. This is caused by the gas that was pumped into the abdomen during the operation.

You may also experience some short-term constipation. You can help reduce this by not taking codeine painkillers, eating plenty of fibre and by staying well hydrated, although your GP can prescribe medication if the problem is particularly troublesome.

Before leaving hospital, you will be advised about caring for your wound and what activities you should avoid. In most cases, you can return to normal activities in a couple of weeks, although more strenuous activities may need to be avoided for four to six weeks after open surgery.

When to seek medical advice

While you recover, it's important to keep an eye out for signs of any problems. Contact the hospital unit where the appendectomy was performed or your GP for advice if you notice:

  • increasing pain and swelling
  • you start vomiting repeatedly
  • a high temperature (fever)
  • any discharge coming from the wound
  • the wound is hot to touch

These symptoms could be a sign of infection.

Risks

Appendectomies are one of the most commonly performed operations in the UK and serious or long-term complications are rare.

However, like all types of surgery, there are some risks. These include:

  • wound infection (although antibiotics may be given before, during or after the operation to minimise the risk of serious infections)
  • bleeding under the skin causing a firm swelling (haematoma) – this will usually get better on its own but you should see your GP if you are concerned
  • scarring – both surgical techniques will leave some scarring where the incisions were made
  • a collection of pus (abscess) – in rare cases, an infection caused by the appendix bursting can lead to an abscess after surgery
  • hernia – at the site of the open incision or any of the incisions used in the laparoscopic approach.

The use of general anaesthetic also carries some risks, such as the risk of an allergic reaction or inhaling any stomach content leading to pneumonia. However, serious complications such as this are very rare.

Alternatives to emergency surgery

In some cases, appendicitis can lead to the development of a lump on the appendix called an 'appendix mass'. This lump, consisting of appendix and fatty tissue, is an attempt by the body to deal with the problem and heal itself.

If an appendix mass is found during an examination, your doctors may decide it is not necessary to operate immediately. Instead, you will be given a course of antibiotics and an appointment will be made for an appendectomy a few weeks later, when the mass has settled.

Another possible alternative to immediate surgery is the use of antibiotics to treat appendicitis. However, studies have looked into whether antibiotics could be an alternative to surgery and as yet there is not enough clear evidence to suggest this is the case.




Page last reviewed: 11/02/2014

Next review due: 11/02/2016

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Comments

The 7 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Andy38 said on 21 May 2014

It took two weeks and persistence on my part to get a proper diagnosis and treatment for appendicitis.

29th April - went to GP with severe abdominal pain, sent to A&E, admitted to hospital.

30th April - was told I will probably have a CT scan or an exploritory op. Half a day later was given an x-ray and a subsequent diagnosis of "constipation". I questioned this as I have never suffered from constipation and have a very healthy diet. Sent home with laxitives.

5th May - went back to GP with same painful abdomen - given painkillers and muscle relaxant as my intestine was "probably in spasm".

12th May - went back to GP, sent to A&E. Given an ultra-sound scan of my abdominal organs, but bizarrly no scan of the intense area of pain, was told "ultra-sound is useless on intestinal areas due to the gas in there". Subsequently a doctor sent me home with a promise of giving me an "urgent" CT scan in three weeks time!!!

13th May - took myself to A&E, was told I probably had kidney stones, was given a CT scan, was told I didn't have kidney stones, was admitted to hospital.

Was later told that I probably had Crohne's Disease and that I would be having an exploritory op.

14th May - given exploritory op that subsequently turned into an op to remove my appendix and an abscess thereon.

18th May - discharged from hospital.

From the above, it would have been better from my perspective to have received an exploitory op on 30th April. I remain confused at the attemepts to diagnose my with various things except appendicitis.

On a positive note, I'm relieved I am pain-free and that we got there in the end. The nurses and aux staff ranged from very good to exellent and the anesthetists were also excellent.

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Angraedad said on 12 May 2014

I have just had treatment and my appendix removed. The nurses were great the doctor visits were few and far between. I never saw the same one twice. The information on this website is in my opinion pretty good, and better than the doctors information given to me.
Being the NHS they like to kick you out asap but I will say 24hrs after the op is too soon. I don't think you should leave until you've got rid of the gas, I have been so uncomfortable. 48-72 hours minimum stay after the op. Also insist on a wheel chair to get you to your car. I thought I was going to explode and faint by the time I was at the hospital doors.

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nanashal said on 01 April 2014

I had keyhole surgery on Thursday 27th March at 9pm, I was discharged from hospital next morning 28th! I am in absolute agony. I can't sleep in my bed. I am half sitting, half lying on the sofa. I am nauseous. I think I should have stayed in for at least a full day. My wounds weren't checked and my temperature was 33.6 on discharge. I had no care plan so wasn't sure whether to shower, do I need check up, nothing. Where do we get these dispassionate nursing staff. Don't get me wrong there were 1 or 2 genuinely caring nurses but on the whole.....

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lozziemae said on 28 March 2014

This website really isn't very detailed! I had my appendix taken out via keyhole surgery on tuesday evening. I was expecting pain but not this much. During the surgery they pump gas into your stomach so they can see as much as possible, when i woke up after the surgery i thought i wouldn't feel any pain because i thought i'd be pumped with painkillers but woke up crying in agony! When i properly came round i noticed that my stomach was double the size (looked like i was 40 weeks pregnant!) I was discharged Thursday afternoon and the gas was still in there. The nurse said it would come out in the next few days (aka i'd fart it out) the pain hasn't eased! It's worse when i move and i can't get comfortable to sleep! This website should explain when happens in more detail, plus the surgeons said 6-8 weeks until i will be back to normal whereas on here it says 1-2 weeks! This needs updating so it's more helpful, i was in less pain before the surgery!

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laylem said on 18 October 2013

This is inaccurate as some cases of appendicitis can be treated with antibiotics. Usually involves a few days in hospital to have IV antibiotics (through a drip going into a vein) then they'll send you home with oral antibiotics. This doesn't have 100% success rate but if you can avoid surgery then in some cases it's worth a try isn't it?

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MagnoliaTree said on 27 March 2013

Following my son's recent experience of a keyhole appendectomy - the surgeon told me several days afterwards that keyhole can be more uncomfortable than open surgery in the first couple of days post-surgery due to the carbon dioxide that's pumped into the abdominal cavity to inflate it during the operation (so that the surgeon can see as much as possible). They take out as much of the gas as they can in theatre, but there is always some left that can sometimes lead to considerable discomfort. Also, the surgeon said if the appendix is badly infected as my son's was, keyhole statistically increases the risk of secondary infection because they can't get full access to 'clean' the abdomen of potentially infectious material after removing the appendix. While keyhole may be better for a straightforward appendectomy where the infection isn't too severe, and I appreciate that doctors can't know exactly what's going on until they 'get in there', I feel there is a tendency to gloss over the potential drawbacks of keyhole and make it sound like it's a breeze. It's still surgery and there can still be complications, just be aware. So don't assume keyhole appendectomy is a walk in the park or that recovery will necessarily be 'fast' as is blithely stated above - it may be so in many cases, I hope it is in yours, but in my son's case he was very ill in hospital for 12 days afterwards. I'm not putting that down to the fact that he had keyhole rather than open surgery, all I'm saying is that there are many other factors that will dictate how 'fast' recovery will be following an appendectomy. I think this particular page on the NHS site doesn't contain enough detail. If it happens to you or a loved one, I'd advise you to pester for as much information as possible at every stage.

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suleman hussain said on 07 June 2012

1 year ago i went to my gp with very bad tummy pain and was told to have a urine test when it was testd it saind i had blood in it and was told to go to the hospital for more looing into theire i was told i had a urinary tract infection ................. 1year later this january i went to my gp again that i had a very bad pain to the right side to my stomach then again i had another urine test with blood in i was sent to the hospital a 1 of being tested for appendisitus the surgeons said we will take the appendix out and look around i had it taken out an was told it was swollen and obstructed i spent 1 week in hospital and was treted well blood in your urine can be a sighn of appendicitis because the appendix is so close to the uretha tube if you have thease pains go straight to your gp love suleman xxxxxxxxxxxxxx

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