Appendectomy

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Overview

Appendectomy is the surgical removal of the appendix, a small, finger-shaped pouch that is located at the cecum (the junction between the large and small intestines). The surgery is the standard treatment for appendicitis (inflammation and infection of the appendix) and patients usually recover from appendectomy without experiencing complications. A ruptured appendix is considered a medical emergency.

Surgeons use one of two surgical techniques, open appendectomy or laparoscopic appendectomy. The choice of method is made by the surgeon on a case-by-case basis.

General anesthesia (agent that renders the patient unconscious) is used in both procedures.

Open appendectomy is the traditional method and the standard treatment for appendicitis. The surgeon makes an incision in the lower right abdomen, pulls the appendix through the incision, ties it off at its base, and removes it. Care is taken to avoid spilling purulent material (pus) from the appendix while it is being removed. The incision is then sutured.

If the appendix has perforated (ruptured), the surgeon cleans the pus out of the abdomen with a warm saline solution to reduce the risk for infection. A drain may be inserted through the incision to allow the pus to drain from the abdomen. In this case, the skin is not sutured, but left open and packed with sterile gauze. The gauze and drain remain in place until the pus is completely drained and there is no sign of infection.

If the abdomen is so inflamed that the surgeon cannot see the appendix, the infection is drained and treated with antibiotics, and then the appendix is removed.

This method has been used for over a decade and it may become the standard of care. The procedure has several advantages including lower risk for postoperative infection, faster recovery time, a smaller scar, and a shorter hospital stay.

The surgeon makes a very small incision right below the navel and inserts an instrument called a laparoscope. The laparoscope is a long tube with a lens at one end and a miniature video camera at the other. The laparoscope enables the doctor to see the appendix. Several more tiny incisions are made to allow for the passage of instruments, which are used to cut and clamp off the appendix.

The laparoscope is also used as a diagnostic tool. The doctor is able to see if the appendix is inflamed and, if the appendix is not the cause of the patient's symptoms, other organs can be seen in order to identify the source of the symptoms.

A number of tests are ordered to assess the patient's health before surgery. Usually these tests are done a few days ahead, but because of the urgency of an appendectomy, the tests and surgery are frequently performed on the same day. Preoperative tests vary according to the patient's age and health, but a blood test, chest x-ray, and electrocardiogram (EKG) are standard.

An informed consent form must be signed acknowledging that the patient understands the procedure, the potential risks, and that they will receive certain medications.

Before surgery, the anesthesiologist visits the patient to do a brief physical examination and to obtain a medical history. He or she will want to know about any other medical conditions; if the patient is taking any medication (prescription or over-the-counter); if any dietary supplements or herbal products are being used; if there has been recent illicit drug use; if the patient smokes cigarettes or drinks alcohol; if the patient has a history of allergies, especially to medications; or has had a previous reaction to anesthesia, or a family history of problems with anesthesia.

Patients are required to refrain from eating or drinking after midnight on the day before surgery; however, because an appendectomy is an emergency procedure, that may not be possible. As soon as the decision is made to operate, the patient must take nothing by mouth, including oral medications.

Prior to surgery, an intravenous (IV) is started to administer fluid and medications that have been ordered, including antibiotics and pain medication. A sedative may be given to help the patient relax. Anesthesia is administered in the operating room.

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