The Condition 

Appendectomy is the surgical removal of the appendix. The operation is done to remove an infected appendix. An infected appendix, called appendicitis, can burst and release bacteria and stool into the abdomen. 

The Appendix 

The appendix is a small pouch that hangs from the large intestine where the small and large intestine join. If the appendix becomes blocked and swollen, bacteria can grow in the pouch. The blocked opening can be from an illness, thick mucus, hard stool, or a tumor. 

Appendicitis 

Appendicitis is an infection of the appendix. The infection and swelling can decrease the blood supply to the wall of the appendix. This leads to tissue death, and the appendix can rupture or burst, causing bacteria and stool to release into the abdomen. This is called  a ruptured appendix.  A ruptured appendix can lead to peritonitis, which is an infection of your entire abdomen. Appendicitis most often affects people between the ages of 10 and 30 years old. It is a common reason for an operation in children, and it is the most common surgical emergency in pregnancy. 

Appendectomy 

An Appendectomy is the surgical removal of the appendix. 

Symptoms 

• Stomach pain that usually starts around the navel and then moves to the lower right side of the abdomen 
• Loss of appetite
• Low fever, usually below 100.3°F
• Nausea and sometimes vomiting
• Diarrhea or constipation 

Treatment Options 

Laparoscopic appendectomy

The appendix is removed with instruments placed into small abdominal incisions. 

Open appendectomy

The appendix is removed through an incision in the lower right abdomen. 

Benefits and Risks 

An appendectomy will remove the infected organ and relieve pain. Once the appendix is removed, appendicitis will not happen again. The risk of not having surgery is the appendix can burst, resulting in an abdominal infection called peritonitis. 

Possible complications include abscess, infection of the wound or abdomen, intestinal blockage, hernia at the incision, pneumonia, risk of premature delivery (if you are pregnant), and death. 

Expectations 

Before your operation

Evaluation usually includes blood work, urinalysis, and an abdominal CT scan, or abdominal ultrasound. Your surgeon and anesthesia provider will review your health history, medications, and options for pain control. 

The day of your operation

You will not be allowed to eat or drink while you are being evaluated for an emergency appendectomy. 

Your recovery

If you have no complications, you usually can go home 1 day after a laparoscopic or open procedure. 

Surgical Treatment 

Acute appendicitis is an urgent problem requiring surgical consultation. 

Laparoscopic Appendectomy 

This technique is the most common for simple appendicitis. The surgeon will make 1 to 3 small incisions in the abdomen.
A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see the appendix more easily.
A laparoscope is inserted through another port. It looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to remove the appendix. The area is washed with sterile fluid to decrease the risk of further infection.
The carbon dioxide comes out through the slits, and then the slits are closed with sutures or staples or covered with glue-like bandage or Steri-Strips. Your surgeon may start with a laparoscopic  technique and need to change to an open technique. This change is done for your safety. 

Open Appendectomy 

The surgeon makes an incision about 2 to 4 inches long in the lower right side of the abdomen. The appendix is removed from the intestine. The area is washed with sterile fluid to decrease the risk of further infection. A small drainage tube may be placed going from the inside to the outside of the abdomen. The drain is usually removed in the hospital. The wound is closed with absorbable sutures and covered with glue-like bandage or Steri-Strips. 

Preparing for Your Operation 

Home Medication 

Appendectomy is usually an emergency procedure. You can help prepare for your operation by telling your surgeon about other medical problems and medications that you are taking. 

Be sure to tell your surgeon if you are taking blood thinners (Plavix, Coumadin, aspirin). 

Anesthesia 

You will meet with your anesthesia provider before the operation. Let him or her know if you have allergies, neurologic disease (epilepsy or stroke), heart disease, stomach problems, lung disease (asthma, emphysema), endocrine disease (diabetes, thyroid conditions), loose teeth, or if you smoke, drink alcohol, use drugs, or take any herbs or vitamins. Let your surgical team know if you smoke and plan to quit. Quitting decreases your complication rate. 

Length of Stay 

Your hospital stay may be longer for a ruptured appendix, if you have severe vomiting, or are unable to pass urine. 

Don’t Eat or Drink 

You will not be allowed to eat or drink while you are being evaluated for appendectomy. Not eating or drinking reduces your risk of complications from anesthesia. 

What to Bring 

• Insurance card and identification
•  List of medicines
• Loose-fitting, comfortable clothes
•  Slip-on shoes that don’t require you to bend over
• Leave jewelry and valuables at home 

Fluids and Anesthesia 

An intravenous line (IV) will be started to give you fluids and medication. For general anesthesia, you will be asleep and pain free during the operation. A tube may be placed down your throat to help you breathe during the operation 

After Your Operation 

You will be moved to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will be closely watched. Be sure that all visitors wash their hands. 

Preventing Pneumonia and Blood Clots 

Movement and deep breathing after your operation can help prevent postoperative complications such as blood clots, fluid in your lungs, and pneumonia. Every hour takes 5 to 10 deep breaths and hold each breath for 3 to 5 seconds. When you have an operation, you are at risk of getting blood clots because of not moving during anesthesia. The longer and more complicated your surgery, the greater the risk. This risk is decreased by getting up and walking 5 to 6 times per day, wearing special support stockings or compression boots on your legs, and for high-risk patients, taking a medication that thins your blood. 

Your Recovery

 Thinking Clearly

The anesthesia may cause you to feel different for 1 or 2 days. Do not drive, drink alcohol, or make any big decisions for at least 2 days. 

Nutrition 

• When you wake up, you will be able to drink small amounts of liquid. If you do not feel sick, you can begin eating regular foods. 
• Continue to drink lots of fluids, usually about 8 to 10 glasses per day. 
• Eat a high-fiber diet so you don’t strain during bowel movements. 

Activity 

• Slowly increase your activity. Be sure to get up and walk every hour or so to prevent blood clots. 
• Do not lift or participate in strenuous activity for 3 to 5 days for laparoscopic and 10 to 14 days for open procedure. 
• You may go home in 1 day. If your appendix ruptured or you have other health issues or complications, you may stay longer. 
• It is normal to feel tired. You may need more sleep than usual. 

Work 

You can go back to work when you feel well enough. Discuss the timing with your surgeon. 

Children can usually go to school 1 week or less after an operation for an unruptured appendix and up to 2 weeks after a ruptured appendix. 

Most children will not return to gym class, sports, and climbing games for 2 to 4 weeks after the operation. 

Wound Care 

• Always wash your hands before and after touching near your incision site. 
• Do not soak in a bathtub until your stitches or Steri-Strips are removed. You may take a shower after the second postoperative day unless you are told not to. 
• Follow your surgeon’s instructions on when to change your bandages. 
• A small amount of drainage from the incision is normal. If the drainage is thick and yellow or the site is red, you may have an infection, so call your surgeon. 
• If you have a drain in one of your incisions, it will be taken out when the drainage stops. 
• Steri-Strips will fall off in 7 to 10 days or they will be removed during your first office visit. 
• If you have a glue-like covering over the incision, allow the glue to flake off on its own. 
• Avoid wearing tight or rough clothing. It may rub your incisions and make it harder for them to heal. 
• Protect the new skin, especially from the sun. The sun can burn and cause darker scarring. 
• Your scar will heal in about 4 to 6 weeks and will become softer and continue to fade over the next year. 
• Sensation around your incision will return in a few weeks or months. 

Bowel Movements 

• After intestinal surgery, you may have loose watery stools for several days. If watery diarrhea lasts longer than 3 days, contact your surgeon. 
• Pain medication (narcotics) can cause constipation. Increase the fiber in your diet with high-fiber foods if you are constipated. Your surgeon may also give you a prescription for a stool softener. 

Splinting your stomach by placing a pillow over your abdomen with firm pressure before coughing or movement can help reduce the pain 

 

When to Contact Your Surgeon

If you have: 

• Pain that will not go away 
• Pain that gets worse 
• A fever of more than 101°F (38.3oC) 
• Repeated vomiting 
• Swelling, redness, bleeding, or bad- smelling drainage from your wound site 
• Strong abdominal pain 
• Odor or increased drainage from your incision
• No bowel movement or unable to pass gas for 3 days 
• Watery diarrhea lasting longer than 3 days 

 

*We provide procedure education for prospective patients and those who educate them. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. The American College of Surgeons (ACS) makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard.