An appendectomy is the surgical removal of the appendix. Your appendix is a worm-shaped hollow pouch attached to the cecum, the beginning of your large intestine. The other side is sealed at the end. If the appendix becomes infected (appendicitis), the infected appendix must be surgically removed (emergency appendectomy) before a hole develops in the appendix and spreads the infection to the entire abdominal space (peritonitis). Appendectomies are performed to treat appendicitis, an inflamed and infected appendix.
Symptoms of Appendicitis
- Abdominal pain beginning in the upper-middle of your abdomen and then develops into sharp localized pain. Pain may be worse when walking or coughing.
- Chills and shaking
- Fever (usually occurs within several hours)
- Loss of appetite
- Rectal tenderness
Causes of Appendicitis
The cause of appendicitis is usually unknown. Appendicitis may occur after a viral infection in your digestive tract, or when the tube connecting the large intestine and appendix is blocked or trapped by stool.
Appendectomies are usually carried out on an emergency basis to treat appendicitis. There are no alternatives, due to the serious consequence of not removing your inflamed appendix: a ruptured appendix and peritonitis, a life-threatening emergency.
The mortality rate of appendicitis has dramatically decreased over time. Currently, the mortality rate is estimated at one to two per 1,000,000 cases of appendicitis. Death is usually due to peritonitis, intra-abdominal abscess, or severe infection following rupture.
Most surgeons decide whether to perform a laparoscopic appendectomy or an open appendectomy based on the individual needs and circumstances of the patient.
- Blood and urine tests
- CT scan
- Physical exam
The hospital staff will start you on IV fluids and antibiotics right away. Since appendicitis is an emergency condition, surgery is almost always done as soon as possible after diagnosis.
A skilled surgeon will make an incision in the lower right section of your abdomen. Most incisions are less than 3 in (7.6 cm) in length. The surgeon then identifies all of your organs in the abdomen and examines them for other disease or abnormalities. Your appendix is located and brought up into the wounds. The surgeon separates your appendix from all the surrounding tissue and its attachment to your cecum and then removes it. The site where your appendix was previously attached, your cecum, is closed and returned to your abdomen. Your muscle layers and then the skin are sewn together. The entire procedure should last less than an hour.
The Risks of an Appendectomy
Risks of an appendectomy are rare, but all surgical procedures have some risk. Your doctor will review potential problems with you.
- Damage to other organs
- Reaction to anesthesia
- Blockage of the bowel
You are more at risk for a complication from surgery if you smoke, drink alcohol or suffer from other chronic diseases, such as diabetes and obesity
The overall complication rate of an appendectomy depends upon the status of your appendix at the time it is removed. Certain risks are present when any operation is performed under general anesthesia, and your abdominal cavity is opened, such as pneumonia, inflammation of the veins, bleeding, and adhesions.
What If My Appendix Burst?
If your appendix has ruptured, your complication rate rises to almost 59%. Wound infections do occur and are more common if your appendicitis is severe, far advanced, or ruptured. An abscess may also form in your abdomen as a complication of appendicitis. Occasionally, your appendix will rupture before it is removed, and its contents spill into your abdominal cavity. Peritonitis or a generalized infection in your abdomen will occur. Treating your peritonitis includes removing what remains of your appendix and inserting drains that promote the flow of the infection through a tube to the outside of your body. Antibiotics will also be administered to you.
Recovery from an Appendectomy
Recovering from your appendectomy is similar to other operations. You are allowed to eat when your stomach and intestines are starting to function again. Usually, your first meal is a clear liquid diet—broth, juice, soda pop, and gelatin. If you can tolerate this meal, your next meal is a regular diet. Taking walks as soon as you can is encouraged. Work and physical education classes may be restricted for a full three weeks after your operation.
The complications associated with undiagnosed, misdiagnosed, or delayed diagnosis of appendicitis are significant, leading to surgeons performing an appendectomy any time they feel appendicitis is the diagnosis. Approximately 20% of the time, a normal appendix will be removed.
Call your doctor immediately if you’re experiencing the following symptoms
- A cough, shortness of breath, chest pain, or severe nausea or vomiting
- Increased abdominal pain
- Lightheadedness or fainting
- Signs of infection, including fever and chills
- Passing blood in the stool
- Persistent nausea and/or vomiting
- Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision sites
If your condition requires advanced treatments beyond your general surgeon’s expertise, your surgeon may refer you to a surgeon with more specialized training.
However, many general surgeons go on to get additional board certifications in surgical specialties including pediatric surgery, bariatric surgery, vascular surgery, gynecology, and urology, just to name a few.
Additionally, a general surgeon can recognize and provide surgical and non-surgical treatment of a multitude of conditions related to management of pain, weight loss, geriatrics and chronic diseases.
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