Appendicectomy (appendix removal)

About appendix removal

Your appendix is a small pouch attached to your large bowel. It’s found in the lower right side of your abdomen (tummy). You will need to have an appendicectomy if you have a condition called appendicitis (inflammation of your appendix). Around eight in 100 people in the UK will have their appendix removed at some point in their life.

There are two different techniques used for an appendicectomy – open surgery and keyhole (laparoscopic) surgery. The keyhole technique is becoming more common than open surgery. Research suggests that it has some advantages, including a shorter stay in hospital and a quicker recovery.

What are the alternatives?

Very rarely, appendicitis may be treated with antibiotics rather than surgery. Usually, this is only if you don’t have access to surgery or you aren’t well enough to have an operation.

Preparing for appendix removal

Your surgeon will explain how to prepare for your operation.

Appendicectomy is done under general anaesthesia. This means you will be asleep during the operation.

You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, it’s important to follow your anaesthetist’s advice and if you’re having an emergency procedure then you may not have time for fasting.

Your nurse may check your heart rate and blood pressure, and test your urine.

You may be asked to wear compression stockings that help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

You will usually be given antibiotics through a tube into a vein in your arm, before you have your operation.

Your surgeon will discuss with you what will happen before, during and after your operation, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during appendix removal

The operation usually takes 30 to 45 minutes, although this depends on the technique used.

If you have keyhole surgery, your surgeon will make two or three small cuts of about 1cm each in your lower abdomen. He or she will remove your appendix using special instruments passed through these cuts. Your surgeon will close the skin cuts with stitches or glue.

If you have open surgery, your surgeon will make a single cut of up to 5cm into your lower abdomen, usually on the right side, and remove your appendix through this cut. He or she will close the cut with stitches or sutures (surgical clips) or glue.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

If you had open surgery, you may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes coming out of your wound. These drain fluid into another bag and are usually removed after a day or two.

When you feel ready, you can begin to drink and eat.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your surgeon’s advice.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

Recovering from appendix removal

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

It will usually take around seven to 10 days before you are ready to return to work or school.

Sometimes, an infection can develop either in your wound or deeper in your abdomen. Contact your GP or the hospital if you develop any of the following symptoms:

  • increasing pain or pain that can’t be controlled with painkillers
  • a high temperature
  • discharge from your wound

What are the risks?

As with every procedure, there are some risks associated with an appendicectomy. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

These are the unwanted, but mostly temporary effects you may get after your procedure, for example feeling sick as a result of the general anaesthetic.

Side-effects of an appendicectomy can include:

  • soreness, swelling and bruising around your wound
  • scarring – you will have a scar, but this usually fades gradually over time

Complications

This is when problems occur during or after the procedure. Most people aren’t affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT).

Complications specific to appendicectomy are uncommon but can include:

  • a wound infection
  • an abscess (a collection of pus) in your abdomen
  • a bowel obstruction caused by scar tissue, which can happen quite some time after your operation

If you’re having keyhole surgery, there is a chance your surgeon may need to convert your keyhole procedure to open surgery.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
 

Are there advantages to having keyhole surgery rather than open surgery?

Answer

A recent study has suggested that there are certain advantages to having keyhole surgery. However, the best type of surgery is specific to you. Your surgeon will talk to you about which type of surgery you can have.

Explanation

The advantages of having keyhole surgery may include:

  • a smaller risk of getting a wound infection
  • less pain after the operation
  • a shorter stay in hospital
  • having several smaller scars instead of one larger one

You may also be able to return to your usual activities more quickly after a keyhole operation than after open surgery.

However, keyhole appendicectomy may take slightly longer than open surgery.

The type of surgery you have will depend on your individual circumstances. Your surgeon will discuss your options with you.

What's a grumbling appendix?

Answer

Grumbling appendix is an old-fashioned name given to pain in the lower abdomen that isn't severe enough to lead to hospital treatment.

Explanation

Pain in the lower abdomen is common and may be short-lived or not severe enough to lead to hospital treatment. Many patients who develop acute appendicitis describe previous pain that was very similar. No doubt this pain sometimes comes from the appendix but doesn't progress to 'full-blown' appendicitis. Often the pain is from an unrelated cause and it usually settles spontaneously. Your doctor may prescribe a course of antibiotics if he or she suspects a urinary infection.

How do I know if my child has appendicitis?

Answer

If your child is complaining of abdominal (tummy) pains, has a high temperature and/or is vomiting then you should get him or her seen by a doctor as soon as possible.

Explanation

In children, the first symptom of appendicitis is often abdominal pain. The pain may start around his or her belly button and then moves to the right side of the lower abdomen. The other symptoms of appendicitis can include a high temperature, vomiting and a loss of appetite.

If you’re concerned about your child’s symptoms, it’s important that you seek medical advice.

If appendicitis isn’t treated, your child’s appendix may burst and this can lead to abdominal infection (peritonitis), which can develop quickly in young children and is a medical emergency.

Are all right-sided lower abdominal pains appendicitis?

Answer

No, right-sided abdominal pain isn't always due to appendicitis.

Explanation

Appendicitis is a common cause of acute abdominal pain. However, there are many reasons why you may have abdominal pain on your right side. In children, it may be caused by conditions such as constipation, a urinary tract infection or gastroenteritis. In women, pain may be caused by their reproductive organs or be due to pregnancy. Women will usually be asked to have a pregnancy test to rule this out.

Sometimes, there may be no reason for your abdominal pain and it may go away on its own. This is called non-specific abdominal pain.