Treating appendicitis 

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.




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Page last reviewed: 11/02/2014

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