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Appendectomy

An appendectomy is the surgical removal of the appendix, a tube about six inches long or less, that branch 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.

Hospital Stay: Hospital Stay: 2 days
Duration: Duration: 30 min - 1 hr
Cost Estimate: Cost Estimate: 1130 USD - 1930 USD These are indicative prices in Indian Hospitals
  • 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 doctor immediately.

Symptoms:

  • Pain in the abdomen
    • 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
    • Increases in severity as time passes
    • Become more severe with moving, taking deep breaths, being touched, and coughing or sneezing
    • May spread throughout the abdomen if the appendix ruptures (peritonitis)
  • Nausea and vomiting
  • Loss of appetite
  • Fever and chills
  • Constipation/diarrhea
  • Inability to pass gas
  • Abdominal swelling.

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

It is important that people 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.

Types of appendectomies

The appendix may be removed in one of the 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 doctor 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 doctor to recommend an appendectomy.

Before the procedure

  • Your doctor 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 doctor 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 health care provider.
  • Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  • Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Notify your doctor 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.
  • You may receive a sedative prior to the procedure to help you relax.
  • Based on your medical condition, your doctor may request other specific preparation.

During the procedure

In general, an appendectomy is performed as emergency surgery and may require a hospital stay. Procedures may vary depending on your condition and your doctor’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.
  • If there is excessive hair at the surgical site, it may be clipped off.
  • The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

Open method appendectomy

  • 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.

Laparoscopic method appendectomy

  • 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.

Procedure completion, both methods

  • 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 or dressing will be applied.

After the Procedure

Patients tend to recover quickly after a simple appendectomy. Most patients leave the hospital in 1 to 2 days after surgery. You can go back to your normal activities within 2 to 4 weeks after leaving the hospital.

Patients who have the appendix removed through small surgical cuts tend to recover and get back to their daily activities faster.

Living without an appendix causes no known health problems.

The appendix produces a bacteria destroying protein called immunoglobulins which help fight infection in the body. Its function, however, is not essential. People who have had appendectomies do not have an increased risk toward infection. Other organs in the body take over this function once the appendix has been removed.

Appendicitis is one of the most common surgical problems. One out of every 2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall. In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each ¼ to ½ inch) while watching an enlarged image of the patient’s internal organs on a television monitor. In some cases, one of the small openings may be lengthened to 2 or 3 inches to complete the procedure.

Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are:

  • Less postoperative pain
  • May shorten hospital stay
  • May result in a quicker return to bowel function
  • Quicker return to normal activity
  • Better cosmetic results

Although laparoscopic appendectomy has many benefits, it may not be appropriate for some patients. Early, non-ruptured appendicitis usually can be removed laparoscopically. Laparoscopic appendectomy is more difficult to perform if there is advanced infection or the appendix has ruptured. A traditional, open procedure using a larger incision may be required to safely remove the infected appendix in these patients.

The words “laparoscopic” and “open” appendectomy describes the techniques a surgeon uses to gain access to the internal surgery site.

Most laparoscopic appendectomies start the same way. Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through a cannula, giving the surgeon a magnified view of the patient’s internal organs on a television monitor. Several other cannulas are inserted to allow the surgeon to work inside and remove the appendix. The entire procedure may be completed through the cannulas or by lengthening one of the small cannula incisions. A drain may be placed during the procedure. This will be removed before you leave the hospital.

In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. Factors that may increase the possibility of converting to the “open” procedure may include:

  • Extensive infection and/or abscess
  • A perforated appendix
  • Obesity
  • A history of prior abdominal surgery causing dense scar tissue
  • Inability to visualize organs
  • Bleeding problems during the operation

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open procedure is strictly based on patient safety.

After the operation, it is important to follow your doctor’s instructions. Although many people feel better in just a few days, remember that your body needs time to heal.

  • You are encouraged to be out of bed the day after surgery and to walk. This will help diminish the risk of blood clots in your legs and of soreness in your muscles.
  • You will probably be able to get back to most of your normal activities in one to two weeks time. These activities include showering, driving, walking up stairs, working and engaging in sexual intercourse.
  • If you have prolonged soreness or are getting no relief from the prescribed pain medication, you should notify your surgeon.
  • You should call your surgeon and schedule a follow up appointment for about 1-2 weeks following your operation.

As with any operation, there are risks including the risk of complications. However, the risk of one of these complications occurring is no higher than if the operation was done with the open technique.

  • Bleeding
  • Infection
  • Removal of a normal appendix
  • A leak at the edge of the colon where the appendix was removed
  • Injury to adjacent organs such as the small intestine, ureter, or bladder.
  • Blood clot to the lungs

It is important for you to recognize the early signs of possible complications. Contact your surgeon if you have severe abdominal pain, fever, chills or rectal bleeding.

Be sure to call your physician or surgeon if you develop any of the following:

  • Persistent fever over 101°F (39°C)
  • Bleeding
  • Increasing abdominal swelling
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • Chills
  • Persistent cough or shortness of breath
  • Purulent drainage (pus) from any incision
  • Redness surrounding any of your incisions that is worsening or getting bigger
  • You are unable to eat or drink liquids

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