Appendectomy (patient information)

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 * Associate Editor-in-Chief: Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

Overview
An Appendicectomy (or Appendectomy) is surgery to remove the appendix, Usually it is removed using small surgical cuts and a camera. This is called a laparoscopic appendectomy. Appendicitis is a painful swelling and infection of the appendix.

Once diagnosed, the Inflamed appendix should be removed as early as possible to avoid complications, such as perforation.

How is Appendectomy done?
The appendix is a small, finger-shaped organ that comes out from the first part of the large intestine. It is removed when it becomes swollen (inflamed) or infected. An appendix that has a hole in it (perforated) can leak and infect the entire abdomen area, which can be life-threatening.

If appendicitis is suspected, a doctor will often suggest surgery without conducting extensive diagnostic testing. Prompt surgery decreases the likelihood the appendix will burst. Surgery to remove the appendix is called appendectomy and can be done two ways.
 * The older method, called laparotomy, removes the appendix through a single incision in the lower right area of the abdomen.
 * The newer method, called laparoscopic surgery, uses several smaller incisions and special surgical tools fed through the incisions to remove the appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time.

Surgery occasionally reveals a normal appendix. In such cases, many surgeons will remove the healthy appendix to eliminate the future possibility of appendicitis. Occasionally, surgery reveals a different problem, which may also be corrected during surgery. It is not clear if the appendix has an important role in the body. There are no major, long-term health problems resulting from removing the appendix although a slight increase in some diseases has been noted, for example, Crohn's disease.

Sometimes an abscess forms around a burst appendix—called an appendiceal abscess. An abscess is a pus-filled mass that results from the body's attempt to keep an infection from spreading. An abscess may be addressed during surgery or, more commonly, drained before surgery. To drain an abscess, a tube is placed in the abscess through the abdominal wall. CT is used to help find the abscess. The drainage tube is left in place for about 2 weeks while antibiotics are given to treat infection. Six to 8 weeks later, when infection and inflammation are under control, surgery is performed to remove what remains of the burst appendix.

An appendectomy is done using either:


 * Spinal anesthesia. Medicine is put into your back to make you numb below your waist. You will also get medicine to make you sleepy.
 * General anesthesia. You will be asleep and not feel any pain during the surgery.

Who needs Appendectomy?
An appendectomy is done for appendicitis. The condition can be hard to diagnose, especially in children, older people, and women of childbearing age.

Most often, the first symptom is pain around your belly button.

Other symptoms include:
 * The pain may be mild at first, but it becomes sharp and severe.
 * The pain often moves into your right lower abdomen and becomes more focused in this area.


 * Diarrhea or constipation.
 * Fever (usually not very high).
 * Nausea and vomiting.
 * Reduced appetite.

Where to find centers that perform Appendectomy?
Directions to Hospitals Performing Appendicectomy

What are the risks of Appendectomy?
Risks from any anesthesia include the following:

Risks from any surgery include the following:
 * Reactions to medications.
 * Problems breathing.

Other risks with an appendectomy after a ruptured appendix include the following:
 * Bleeding.
 * infection of the wound.


 * Buildup of pus (abscess), which may need draining and antibiotics.
 * Longer hospital stays.
 * Side effects from medications.

What to expect before the procedure?
If you have symptoms of appendicitis, seek medical help right away. Do not use heating pads, enemas, laxatives, or other home treatments to try and relieve symptoms.

Your health care provider will examine your abdomen and rectum. Other tests may be done.


 * Laboratory tests

Blood tests are used to check for signs of infection, such as a high white blood cell count. Blood tests may also show dehydration or fluid and electrolyte imbalances. Urinalysis is used to rule out a urinary tract infection. Doctors may also order a pregnancy test for women.


 * Imaging tests

Computerized tomography (CT) scans, which create cross-sectional images of the body, can help diagnose appendicitis and other sources of abdominal pain. Ultrasound is sometimes used to look for signs of appendicitis, especially in people who are thin or young. An abdominal x-ray is rarely helpful in diagnosing appendicitis but can be used to look for other sources of abdominal pain. Women of childbearing age should have a pregnancy test before undergoing x-rays or CT scanning. Both use radiation and can be harmful to a developing fetus. Ultrasound does not use radiation and is not harmful to a fetus.

There are no actual tests to confirm that you have appendicitis. Other illnesses can cause the same or similar symptoms.

The goal is to remove an infected appendix before it breaks open (ruptures). After reviewing your symptoms and the results of the physical exam and medical tests, your surgeon will decide whether you need surgery.

What to expect after the procedure?
With adequate care, most people recover from appendicitis and do not need to make changes to diet, exercise, or lifestyle. Full recovery from surgery takes about 4 to 6 weeks. Limiting physical activity during this time allows tissues to heal.

After an uncomplicated appendectomy, your surgeon will usually advise you to: 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:
 * 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.
 * 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.

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

Recovery is slower and more complicated if the appendix has broken open or an abscess has formed.

Living without an appendix causes no known health problems.

Videos

 * Laparoscopic Appendectomy video.