Appendectomy

What is an appendectomy?

An appendectomy is a surgical procedure done to remove the appendix. It is a treatment modality that is instituted when one has appendicitis. Appendicitis is an inflammation of the appendix and is one of the major causes of acute abdomen. Acute abdomen on the other hand is any severe pain occurring in the abdomen that is life threatening and requiring urgent intervention.

The appendix is a vestigial organ (meaning that its usefulness is not exactly known) that is small-sized, cylindrically-shaped and joined to the intestine. It is situated in the right side of the abdomen. Its commonest position is behind the caecum. Some schools of thought believe that the appendix may be of use in helping us heal from diarrhea, inflammation or from infections affecting the small and large intestines. Despite the said usefulness, the body can still function maximally in the absence of an appendix.

When the appendix gets inflamed, it swells up and permits the proliferation of bacteria within it and subsequent formation of pus. This accumulation of bacteria and pus can lead to pain around the navel, this pain is characteristically acute in onset, radiates to the right lower abdomen and can be worsened by walking or coughing. Nausea, vomiting or diarrhea may also be experienced.

Seek intervention immediately if you notice symptoms of appendicitis. When left untreated, the appendix can rupture thereby letting in harmful bacteria and other harmful substances to the abdomen thus causing more harm almost up to the point of becoming a threat to life and prolonging hospital stay. An appendectomy is a definitive treatment for appendicitis. It is best to remove the appendix rather than to let it rupture. Following an appendectomy, the majority of people recover quickly with no complications.

Why is an appendectomy performed?

An appendectomy is done to get rid of the infected appendix which may have been inflamed and swollen. The infection is called appendicitis and it happens when the entrance of the appendix is filled with bacteria and feces thereby making the appendix to get hard and swollen. The fastest and easiest way to treat appendicitis is by removing the appendix. The appendix could likely rupture if not removed immediately. When an appendix bursts, it releases bacteria, stool particles, and pus cells into the abdomen thereby leading to a more complicated infection known as Peritonitis. An appendicle abscess can also develop following a rupture and the above two conditions are emergencies that require urgent surgery as they may be fatal.

Appendectomy
Photo Credit: MyHealth Alberta

Symptoms

  • The constant feature is the pain. Abdominal pain usually starts around the navel and radiates to the lower right side of the abdomen
  • Rigid abdominal muscles
  • Constipation or diarrhea
  • Nausea
  • Vomiting
  • Anorexia
  • Fever that is low grade

The pain in appendicitis usually occurs in the right upper region of the abdomen but this is not the case in pregnant women as this pain occurs higher up in them because of the space taken up by the growing fetus. Visit an emergency room urgently if you suspect appendicitis so that surgery can be done to get out the inflamed appendix and prevent possible complications.

Risks involved in an appendectomy

An appendectomy is not associated with that much risk as it is a rather simple and common procedure. However, minimal risks may be involved and they include bleeding, infection, injury to nearby organs and obstructed bowels.

It is worthy of note that the risks involved in an appendectomy are not as severe as that for appendicitis that is left untreated. To prevent abscess from developing or peritonitis, an appendectomy should be done.

Preparing for an appendectomy

An 8-hour or more fasting is necessary for an appendectomy. Do well to inform your doctor about any medications you are taking whether they are prescription drugs or over-the-counter-drugs. The doctor will regulate its use prior to the surgery. Tell your doctor if you are pregnant, have an allergy to latex or other substances, have had a bad anesthetic history or a history of bleeding disorders.

Get a friend or relative to drive you home after the surgery since the general anesthesia given will make one drowsy and unable to drive for some hours after the surgery.

When you present at the hospital, you will be asked about your medical history by the doctor and a physical examination will also be performed. Since appendicitis is a clinical diagnosis, the doctor will try to elicit the location of the abdominal pain by pushing gently against the abdomen.

When appendicitis is caught early enough, there may be time to perform some blood tests and imaging but when it’s in an emergency state, an appendectomy can be instituted immediately. Prior to the appendectomy, you will be connected to an IV so you can receive fluids and medications. General anesthesia is used in most cases which means that you will be asleep while the surgery goes on. In a few cases, local anesthesia can be given and this only numbs the surgical area although the patient will be awake during the surgery.

PROCEDURE FOR AN APPENDECTOMY

An appendectomy can be performed either via open surgery or laparoscopic surgery. The doctor chooses the one that is best for the patient after considering individual factors and general factors such as the patients’ medical history and the severity of appendicitis.

Open appendectomy

Here, a cut is made in the lower right side of the abdomen to reveal the appendix, the appendix is removed and the wound is sutured. This particular surgical mode allows for cleaning of the abdominal cavity in the case of a ruptured appendix.

An open appendectomy is chosen in the case of a ruptured appendix with subsequent spread of infection to nearby organs. It is also better for people who have had abdominal surgery in the past.

Laparoscopic appendectomy

Here, tiny cuts will be made in the abdomen to accommodate a cannula. The cannula is then fitted into the abdomen and carbon dioxide is passed through it to inflate the abdomen, this gives a much clearer field so the surgeon can visualize the appendix better.

Upon inflation of the abdomen, a laparoscope is put through the tiny cuts that was earlier made. A laparoscope is a tube which is long, equipped with a high-intensity light and high-resolution camera in front of it. The camera produces a picture of the abdomen and the organs thus allowing the surgeon to see inside the abdomen and properly direct his/her instruments. When the appendix is located, it is wound up with stitches and removed. The tiny cuts that were made are then cleaned, sutured and dressed. Laparoscopic surgery is minimally invasive and is usually the best option for older adults and those who are obese. It has lesser risks when compared to open surgery and the recovery time is faster with it.

OUTCOME FOLLOWING AN APPENDECTOMY

After the surgery, the patient is monitored for hours before being discharged. The vital signs including the blood pressure, heart rate, and breathing must be in normal order. Any side effect either to anesthesia or to the surgery will be checked for.

For one to be discharged, the following are taken into consideration;

  • The physical condition of the patient
  • The type of appendectomy that was done
  • The body’s reaction to surgery

In some conditions, one may have to stay back overnight in the hospital.

If the severity was mild, one may be able to go home after the surgery. Get a family member or friend to drive you home especially if you received general anesthesia as this will make one drowsy and its effect may take some time to wear off, thus making one unfit to drive after the surgery.

Some days after the appendectomy, moderate pain may still be felt in the areas surrounding the surgical site. The pain usually lessens as the days go by. Pain relievers are prescribed to help with pain management. Also, antibiotics are prescribed to prevent post-surgical infection. Keep the wound site clean to prevent further infection and be on the lookout for signs of infection which include:

  • Redness
  • Swelling
  • Fever greater than 1010F
  • Chills
  • Vomiting
  • Appetite loss
  • Abdominal cramps
  • Constipation or diarrhea spanning greater than two days.

Even with the fact that an infection is likely to occur, most people recover from appendicitis and an appendectomy without much difficulty. Total recovery may take between 4 to 6 weeks. Bed rest is advised with minimal physical activity to give the body a conducive atmosphere to heal. Do not fail to attend a follow-up appointment with the doctor about 2 to 3 weeks after the surgery.

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