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Appendix Surgery Procedure, Recovery Time & Complications

Appendix surgery, also known as appendectomy, is the surgical procedure to remove an inflamed appendix. It is the standard treatment for appendicitis. Once the appendix becomes inflamed, it could rupture if not treated on time, which becomes a medical emergency. Thus, the appendix is removed as it doesn’t have an essential function in the body.

Why you might need an appendectomy?

You might need an appendectomy if the appendix is sore, swollen, and infected. Appendicitis, i.e., inflammation of the appendix, can be treated with antibiotics in chronic cases. However, the chronic condition can anytime become acute, and the antibiotic medications might stop working. If this happens, the appendix can swell up and burst in 2-5 days. As the appendix bursts, the infection spreads throughout the abdominal cavity, which can lead to peritonitis (inflammation of the abdominal lining). The infection can also enter the bloodstream, which increases the chances of sepsis.

If left untreated, both peritonitis and sepsis can lead to serious illness and death. An appendix can rupture within 36 hours after the symptoms arise. That’s why time is of the essence when you get appendicitis.

Types of Appendix Surgery

An appendix surgery can be performed using either open or laparoscopic techniques. Open appendectomy is the standard procedure, whereas laparoscopic appendectomy is a less invasive method.

  • Open Appendectomy- In this procedure, an incision about 2 to 4 inches long is made on the right side of the abdomen. Then the appendix is directly taken out.
  • Laparoscopic Appendectomy- In this procedure, 3 keyhole-sized incisions are made across the abdomen through the laparoscope, and other surgical instruments are inserted. The laparoscope is a video camera that allows a surgeon to get a clear view of the internal organs. The surgeon looks at the TV monitor to guide the tools, access the appendix, and remove the inflamed appendix.

Though the laparoscopic technique is minimally invasive, it might not be the best option in all cases. Even during the surgery, the surgeon may decide to switch from laparoscopic to open surgery as needed. In case the appendix has burst and infection has spread in the abdominal cavity, an open appendectomy will be performed.

How to prepare for an appendectomy?

To prepare you for surgery, the doctor is likely to explain the procedure in detail and ask if you have any questions. There are no specific preparations required at the patient’s end before appendectomy. You only need to provide the following-

  • A consent form mentioning that you give your permission for the surgery. Make sure that you read the form.
  • Complete medical history so that the doctor can ensure that you are in good health for the surgery.
  • Give a list of all the medications (prescribed and over-the-counter) that you take, including herbs, vitamins, and other supplements.
  • Let the doctor know if you have a history of bleeding disorders or if you take blood-thinning medications. You may have to stop taking these medicines prior to surgery as they can increase the risk of excessive bleeding.
  • Provide information about your allergies or certain medications that may be used in anesthesia.

Other instructions that you may receive from the surgeon can include the following points-

  • Do not eat or drink anything 8 hours before the surgery.
  • Take your medications with a small sip of water.
  • Wear loose and comfortable clothes that can be removed and worn easily.
  • Do not wear jewelry or any accessory as they will be removed before the surgery.
  • Ask a friend or family member to accompany you and take you back after the procedure.

The doctor may provide further instructions depending on your health.

What happens during an appendectomy?

Before taking you to the operating room, an IV line will be placed in your arm or hand. If there is significant hair growth in the surgical site, the hair will be trimmed. Your heart rate, blood pressure, breathing, and blood oxygen levels are checked before the surgery and regularly monitored during the procedure too.

Depending on the technique chosen for appendix removal, the steps will vary.

In Open Appendectomy

  • An incision is made in the lower right side of the abdomen, right above the appendix.
  • The abdominal muscles are separated to access the appendix.
  • The connection between the intestine and appendix is tied off with stitches, and the organ is taken out.
  • In case your appendix has burst or ruptured, the abdomen will be washed out with saline water.
  • The abdomen lining and muscles are closed with stitches. A small tube may also be placed in the incision to drain the fluids.
  • The incisions will be covered by steri strips, dressing, or bandages.

In Laparoscopic Appendectomy

  • A tiny incision is made to insert the laparoscope, and other incisions to insert the surgical tools.
  • Carbon Dioxide gas is used to inflate the abdomen to make ample space to perform the surgery without damaging other organs. The inflation also allows the surgeon to guide the laparoscope and surgical instruments properly.
  • The appendix is identified, tied with stitches, and removed carefully through the incision.
  • After appendix removal, the abdomen is cleaned and deflated.
  • A small drainage tube is placed in the incision to drain out the fluids, including water and blood.
  • The incisions are closed and covered with a sterile bandage or dressing.

After the Surgery

At the hospital

Immediately after the surgery, you will be transferred to your recovery room. The nursing staff will monitor your vital signs, such as heart rate, breathing, etc. After ensuring that your vitals are stable and you wake up, you will be transferred to your hospital room.

Laparoscopic appendectomy is done on an outpatient basis. Thus, in this case, you will get discharged on the same day.

In case of open surgery, you will be kept under observation for 1-2 days. The IV line will be connected to your arm or hand, and the pain medication will be given through that. The doctor will ask you to get out of bed after the surgery, and you may be able to eat or normally drink after a few days.

During discharge, the doctor will give you a recovery guide, the dietitian will give you a diet chart, and some tips to prevent complications while you recover at home.

At home

Most of your recovery will happen at home. Thus, it is crucial that you know what to expect during the recovery phase. In the initial days, you will be asked to take proper rest to prevent the stitches from tearing.

The first follow-up will be after 7 to 10 days when the surgeon will remove the stitches. The doctor will also check if there are any signs of complications. Your prescribed medications will also be updated, and the doctor will give you the next follow-up date.

Throughout the recovery phase, if the following signs appear, please contact your healthcare provider immediately-

  • Fever or chills
  • Redness or swelling
  • Bleeding or fluid drainage from the incision
  • Persistent pain in the incision site
  • Vomiting or loss of appetite
  • Constant cough or shortness of breath
  • No bowel movement for 2 or more days

Risks & Complications of Appendix Surgery

Appendix surgery has the following risks and complications-

  • Wound Infection- Antibiotics are given before, during, and after the surgery to reduce the risk of infection.
  • Hematoma- Blood accumulation is common after surgery and often resolves on its own.
  • Pus Accumulation- In cases when the appendix bursts, there are chances of abscess formation.
  • Bowel Obstruction- If fibrous bands of tissues, i.e., adhesions, form after the surgery, it can obstruct the bowel and prevent the passage of stool, gas, and fluids through the intestine.

You may also experience some side effects, such as nausea, constipation, abdominal bloating, etc., over the next few days after surgery.

Recovery

The recovery time is very crucial for the patient. The exact time varies for each patient depending on the type of surgery- open or laparoscopic and the patient’s healing abilities. Complete recovery takes around 2 to 4 weeks, during which you will be asked to take care of the following things-

  • Take the prescribed medications as directed by your doctor without fail.
  • Get proper for 1-2 days after the surgery and then gradually start moving around and resuming basic activities.
  • Eat bland and soft foods until your bowel movements are normal again. Resume your standard diet slowly.
  • Limit your physical activity to ensure that you don’t tear up the stitches.
  • Avoid strenuous activities or exercising until the doctor gives you permission.
  • Do not swim or take baths in hot tubs, as immersing the wound can cause maceration or weakening of the incision line.
  • If you are taking over-the-counter medications, make sure that you consult your doctor and take his permission.
  • Avoid taking showers for the first few days. You can take a bath after 4 days of surgery.
  • Do not perform strenuous activities, such as lifting heavy objects, running, or doing gym exercises.
  • Try to avoid fast foods, fried and oily foods, canned or preserved foods, etc., as they are hard to digest.
  • Drink plenty of water and other fluids to keep the body hydrated and prevent constipation.
  • Start walking around when you feel comfortable but don’t push yourself if you feel pain.
  • Do not drive until you stop taking the pain medications and the doctor gives you permission to do so.
  • Do not miss your follow-up appointments.
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