Appendectomy

An appendectomy is a surgical operation to remove the appendix, a small finger-shaped pouch attached to the large intestine in the lower-right side of the abdomen.

The appendix has no known essential function in adults. When it becomes blocked — by stool, mucus, or other material — bacteria multiply inside it, causing the tissue to swell and fill with pus. This is called appendicitis (inflammation of the appendix). If the appendix is not removed in time, it can burst and spread infection throughout the abdomen, which is a life-threatening emergency. Removing the appendix stops this from happening and, because the appendix is not essential, the body works normally without it.

An appendectomy is most often performed as an emergency procedure, though it is sometimes planned in advance when symptoms are milder. The main reason for the operation is acute appendicitis (a sudden, severe inflammation of the appendix), but doctors may also recommend it in a few other situations.

• Acute appendicitis — sudden pain, fever, and nausea caused by a blocked and infected appendix.
• Perforated appendicitis — a burst appendix that has already spilled infection into the abdomen.
• Peritonitis (infection and inflammation of the lining of the abdomen) resulting from a ruptured appendix.
• Abscess (a pocket of pus) around the appendix that does not resolve with antibiotics alone.
• Recurrent appendicitis — repeated episodes of milder inflammation that keep coming back.
• Appendix tumour — in rare cases, a growth found in or near the appendix during investigation.

There are situations where immediate surgery may be approached differently or delayed. Your surgeon will assess each case individually.

• A well-contained abscess may first be drained and treated with antibiotics, with surgery planned later.
• Patients with very high anaesthetic (sleeping medicine) risk due to other serious illnesses may be managed differently.
• In a small number of mild, uncomplicated cases, doctors may try antibiotics alone as a first step — though surgery remains the most reliable treatment.

An appendectomy is a well-established operation, but like any surgery it carries risks that your surgical team will explain and monitor for.

• Wound infection — redness, swelling, or discharge at the incision site, more common after a burst appendix.
• Intra-abdominal abscess (a collection of pus inside the abdomen) — more likely if the appendix had already ruptured before surgery.
• Bleeding during or after the operation, which may rarely require a second procedure.
• Injury to nearby structures — such as the bowel (intestine), bladder, or blood vessels — which is uncommon but possible.
• Ileus (the bowel temporarily stopping its normal movement) causing bloating and inability to eat for a few days.
• Blood clots in the leg veins (deep vein thrombosis), especially after longer or more complex operations.
• Reactions to anaesthesia (the medicines used to keep you unconscious and pain-free), such as nausea or, rarely, breathing difficulty.
• Hernia (a bulge through the abdominal wall) at the incision site, which can develop weeks or months later.
• Conversion from keyhole to open surgery — if the laparoscopic (keyhole) approach becomes unsafe, the surgeon will switch to a larger incision.

Because appendicitis is usually an emergency, preparation time is often very short — sometimes only an hour or two. The team will complete as many of these steps as time allows. If surgery is planned in advance for a non-emergency situation, more thorough preparation is possible.

Before surgery, patients are usually asked to avoid eating solid food and to limit fluids for a set period — your team will give specific instructions based on when the operation is scheduled. Smoking and alcohol increase the risk of complications; if there is time, stopping both even briefly is helpful. The team will review any regular medications and decide which to continue, pause, or adjust — blood thinners and diabetes medicines often need special management. Do not stop or change any medicine without guidance from the surgical team.

The following tests are commonly performed before the operation:

• Blood tests — to check for signs of infection, anaemia (low blood count), and to assess kidney and liver function.
• Urine test — to rule out a urinary tract infection or kidney stone, which can mimic appendicitis.
• Ultrasound (USG) of the abdomen — often the first imaging test used.
• CT scan (a detailed X-ray) of the abdomen and pelvis — gives a clearer picture when the diagnosis is uncertain.
• Pregnancy test for women of childbearing age — results affect decisions about imaging and anaesthesia.
• EKG (heart tracing) and chest X-ray — usually for older patients or those with heart or lung conditions.

During the procedure itself, the following steps generally take place — though the exact order and details vary between hospitals and surgeons:

• 1. You are moved to the operating room and connected to monitoring equipment for your heart rate, blood pressure, and oxygen level.
• 2. A general anaesthetic (full sleeping medicine given through a drip and breathing tube) is administered, so you are completely unconscious throughout.
• 3. The surgical team cleans the skin of your abdomen with antiseptic solution.
• 4. In a laparoscopic (keyhole) approach, the surgeon makes two or three small cuts, usually less than a centimetre each, and inserts a thin camera (laparoscope) and instruments. In an open approach, one larger cut is made in the lower-right abdomen.
• 5. The abdomen is gently inflated with carbon dioxide gas to create space for the surgeon to see and work (laparoscopic only).
• 6. The surgeon locates the appendix, cuts the blood vessels supplying it, seals or ties the base where it joins the large intestine, and removes the appendix.
• 7. If there is pus or spillage from a burst appendix, the area is washed out with sterile fluid.
• 8. The instruments are removed, gas is released, and the small cuts or large incision are closed with stitches or staples and covered with a dressing.
• 9. You are moved to a recovery room where nurses monitor you as the anaesthetic wears off.

Recovery after an appendectomy depends on whether the operation was laparoscopic or open, and whether the appendix had burst before surgery. Laparoscopic surgery generally allows a faster return to normal activities; a burst appendix means a longer hospital stay and more intensive care. Your surgical team will guide you through each stage.

• Hospital stay: Most patients who had a straightforward laparoscopic appendectomy are discharged within one to two days. Open surgery or a ruptured appendix usually means staying longer — sometimes several days.
• Pain management: Discomfort around the incision sites and, after laparoscopy, sometimes in the shoulder (from residual gas) is normal. The team will prescribe appropriate pain relief.
• Diet: Most patients start with clear liquids and progress to normal food over a few days as the bowel wakes up. Nausea and mild bloating are common in the first day or two.
• Wound care: The dressing should be kept clean and dry according to the team's instructions. Stitches may dissolve on their own or need removal at a follow-up visit, depending on the type used.
• Activity restrictions: Light walking is encouraged soon after surgery to help prevent blood clots. Strenuous exercise, heavy lifting, and driving are usually restricted for several weeks — your surgeon will advise when it is safe to resume each activity.
• Antibiotics: Patients who had a burst appendix or significant infection are usually sent home with a course of oral antibiotics to complete.
• Follow-up appointment: A check-up is typically scheduled one to four weeks after discharge to inspect the wound, review any biopsy (tissue test) results from the removed appendix, and confirm recovery.
• Warning signs to report promptly: increasing pain, fever above 38 °C, redness or discharge from the wound, vomiting that prevents eating or drinking, or inability to pass gas or stool.
• Return to work and normal life: Many patients return to desk work within two to four weeks after laparoscopic surgery; physical or manual work takes longer. Your doctor will decide based on how your recovery progresses.