An appendectomy, also termed appendicectomy, is quite a straightforward surgical procedure to remove the vermiform appendix. It is usually an emergency procedure that is carried out to treat an inflamed or infected appendix, a condition commonly known as appendicitis.
Appendectomy and inflamed appendix

What Is The Appendix?

The appendix is a small, tube or finger-shaped pouch attached to the large intestine, located in the lower right side of the abdomen projecting out from the cecum (the beginning of the colon). Although, the exact purpose of the appendix isn’t known, yet it is believed that it may help one recover from certain inflammatory conditions, diarrhoea and infections of the small and large intestines. The functions may sound important, but the truth is, that the body can still function properly without an appendix.

What Is Appendicitis?

Appendicitis is a painful, inflammatory condition that chiefly occurs when a blockage forms inside the appendix leading to increased pressure, altered blood flow, and inflammation. When the appendix becomes inflamed and swollen, the tissues become infected with the bacteria that can quickly multiply inside the organ and lead to the formation of pus. The appendix may also get blocked mechanically due to passage of hard stool, a foreign body, or thick mucus leading to bacterial infections. This accumulation of bacteria and pus can cause pain around the belly button that spreads to the lower right section of the abdomen. Though the onset of pain is usually sudden, it increases over time without treatment. Other symptoms that some people witness include:

  • Abdominal swelling
  • Stomach pain
  • Rigid abdominal muscles
  • Constipation or diarrhea
  • Loss of appetite
  • Nausea and vomiting
  • Inability to pass gas
  • Mild fever

Also Read: Appendicitis: Causes, Symptoms and Treatment

Why Is  Appendectomy Performed ?

Appendectomy is an emergency surgical procedure that is often suggested by the treating doctor to remove the appendix when an infection has made it inflamed and swollen, a condition medically termed as appendicitis.

Why Is Appendectomy An Emergency Surgery?

Since the appendix is a small pouch, it swells quickly with inflammation and doesn’t take much time to burst. A burst appendix can spread various infectious agents throughout the abdominal cavity, often leading to peritonitis, an inflammation of the abdominal lining. If the infection spreads to the bloodstream, it can also lead to sepsis. Both peritonitis and sepsis can cause grave illness and sometimes even death. The appendix can rupture within 36 to 48 hours of the onset of the first symptoms, so do seek medical help at the earliest to avoid life-threatening complications.

Also Read: Appendix Cancer: Causes, Symptoms And Treatment

What Are The Complications Of Appendectomy?

An Appendectomy is quite a common and simple surgical procedure. However, some complications attached to the surgery may include:

  • Bleeding
  • Wound infection
  • Reactions to medicines
  • Problems while breathing
  • Blood clots
  • Blocked bowels
  • Injury to nearby organs

Incase the appendix bursts before the surgery, common complications would include:

  • Infection and redness and swelling (inflammation) of the belly and the incision
  • Buildup of pus (abscess), which may need draining and injecting antibiotics

How To Prepare For An Appendectomy?

The patient undergoing the surgery must disclose about any over-the-counter or prescription medications that he or she might be taking since it can interfere with the operation. The person must not eat or drink anything for at least 8 hours prior to the surgery.

The patient must also disclose to the doctor:

  • If she is pregnant or believe to be pregnant.
  • Are allergic or sensitive to latex or certain medications, such as anesthesia
  • Have a previous history of bleeding disorders

Once  the patient is at the hospital, the doctor might acknowledge about the medical history and perform a physical examination to make sure that the patient is in good health before the surgery.

The doctor may also conduct some blood tests and imaging tests if the appendicitis is caught early.

Before going through the procedure, the doctor or nurse might hook up the patient to an IV so as to provide fluids and medications. Next, the doctor might put the patient under general anesthesia, which means he or she would be asleep during surgery or apply local anesthesia which just numbs the operational area, so even though the patient is awake during the surgery, he or she won’t feel any pain.

How Is Appendectomy Performed?

For the procedure, the patient has to remove any piece of jewelry and change into a hospital gown, and then proceed to the operating room. An IV (intravenous) line is put in the arm or hand. Then, the patient has to lie on the back and a general anesthesia is injected to put him or her into a deep sleep. If there is a lot of hair at the surgical site, the attendants usually clips it off before the surgery. The patient is also given a muscle relaxant to prevent muscle spasms during the procedure. Next, a thin tube is placed through the mouth into the throat to maintain a clear airway and monitor breathing. The anesthesiologist then monitors the heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

An Appendectomy can be performed in two ways depending upon the condition of the patient and the doctor’s preference. They are Open Appendectomy and Laparoscopic Appendectomy.

Open appendectomy

During an open appendectomy, an incision of 2-4 inches is made in the lower right part of the belly. The abdominal muscles are separated and the abdominal area is opened. The appendix is then tied off with stitches and removed carefully. In case, the appendix has burst or ruptured, the abdomen will be washed out with salt water (saline) and the lining of the abdomen and the abdominal muscles are closed with stitches. A small tube is put in the incision area during the surgery to drain out any fluids.

Laparoscopic Appendectomy

This method is less invasive and provides faster recovery. During this process, instead of one big incision, 1 to 3 tiny cuts are made. A long, thin tube called a laparoscope is put into one of the incisions. It has a tiny video camera and surgical tools. Next, carbon dioxide gas is used to swell up the abdomen so that the appendix and other organs can be easily seen. The surgeon mainly looks at a TV monitor to see the inside of the abdomen and guide the tools inside the body. The appendix is tied off with stitches and easily removed through one of the incisions. After completion of the surgery, the laparoscope and tools are removed. The carbon dioxide is let out through the cuts. A small tube is placed in the cut to drain out any excess fluids.

After the surgery is completed in both cases, the appendix is sent to a lab for further testing. The cuts are closed with stitches or surgical staples. A sterile bandage or dressing is used to cover the wounds.

What Happens After An Appendectomy?

After the surgery, the patient is taken to the recovery room. The healthcare team mainly watches the vital signs, such as the heart rate and breathing. The recovery chiefly depends on the type of surgery that was done and the type of anesthesia the patient had. Once the blood pressure, pulse, and breathing are stable and the patient is awake and alert, the doctor decides whether he or she should be allowed to go home or stay in the night.

In case, the patient underwent an uncomplicated laparoscopic appendectomy, the doctor might allow the patient to go home the same day. In such scenario, the patient needs to have someone else drive him or her back home, as the anesthesia takes some time to wear off. But in case, the patient underwent a ruptured appendix or open surgery, the doctor might ask the patient to be in the hospital for a few more days for follow up. The doctor usually continues intravenous antibiotics while the healthcare team monitors the condition.

What Are The Side-effects Of An Appendectomy?

Common side effects of the surgery include:

  • Nausea
  • Constipation
  • Gas pain after laparoscopy which can extend to the chest and shoulders
  • Abdominal bloating which usually diminishes over the next several weeks

How Long Does It Take To Recover From An Appendectomy?

The recovery time of Appendectomy usually varies depending on how complicated the appendicitis and surgery were and how the body responded to the surgery. In general, the pain and side effects generally reduces within a few days. It may take a few days to weeks to return to the normal activities. Most people recover fully within six weeks. Also the patient must take care, that that the prescribed medications are taken in time to speed up healing and avoid further infection. But the doctor must be informed in case the patient notices any signs of infection including redness and swelling around the incision, fever with chills, stomach cramps, loss of appetite, vomiting, diarrhoea etc.