Appendicitis and Appendectomy: Surgery and Recovery

By AdminPosted On 25-04-2019

An appendectomy is a surgical procedure to remove an infected or inflamed appendix, a condition known as appendicitis. Vermiform Appendix or simply appendix is a worm or finger-shaped pouch that projects out from the cecum (pouch or large tube-like structure that connects the small intestine to the colon). The cecum’s job is to receive undigested food from the small intestine, absorb fluids, salts and electrolytes (such as sodium and potassium) that remain after food is digested, and mix them with mucus to lubricate the solid waste for easier elimination. In that, the function of the appendix in the human body is not yet fully established. But it is not redundant; researchers hypothesize that it has other functions when we are young.

Appendicitis is relatively common, as almost one out of every 15 people may develop the condition in their lifetime. Appendicitis is most prevalent in people between the ages of 10-20. Though age is no exempt, there is a male preponderance. The symptoms can also manifest differently depending on the person’s age. For example, in adolescents, appendicitis can begin as a peri-umbilical colicky pain which may progress to the lower right side of the abdomen. Meanwhile, children with appendicitis experience a symptom commonly referred to as "rebound tenderness." Also called as Blumberg’s sign, this is a sharp pain that occurs when pressure is quickly applied to and removed from the lower right abdomen.


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What causes appendicitis? 

Your appendix is not speculated to be an evolutionary remnant of little significance to normal physiology but, in fact, it’s considered to be a working part of your immune system when you are young. The research about the functions of appendix is still going on. When you get older, your appendix is assumed to stop its mucosal immune function as other parts of your body takes charge to fight infection. The cause of Appendicitis is not exactly known and there can also be multiple causes for one case of appendicitis. (The suffix “-itis” in appendicitis means inflamed).

This may be caused by various infections such as virus, bacteria, or parasites, in your digestive tract. Sometimes, obstructions due to enlarged lymphoid follicles, worms, trauma and even tumours can cause infection due to accumulation of fecal matter. The blood supply to the appendix stops (which causes gangrene) as the swelling and soreness get worse. As pus fills its interior cavity, the appendix swells up and it can grow several times larger than its average 3-inch size. The clogged appendix will eventually rupture as its walls start to get holes. These holes let fecal matter, mucus, and other things leak through and infecting the abdomen which also leads to peritonitis. This is a serious condition which can lead to more infection and even death.

Appendicitis Surgery

Appendectomy is the surgical removal of the appendix and they are the most commonly performed emergency procedure for the abdomen. The appendix may be removed in an open appendectomy or using laparoscopic methods:

Open (traditional) appendectomy: surgeon will make a single, two- to three-inch-long incision in the lower right side of your abdomen (above hip bone). The surgeon will pull the appendix from large intestine to the surface for better access, cut the appendix out, then wash the area with sterile fluid and close the incision. If the appendix has ruptured, a small shunt (tube) may be placed to suction out pus and other fluids in the belly. The shunt will be removed in a few days, when the surgeon feels the infection has been eliminated. The surgery, from the initiation of anesthesia to bandaging, takes less than an hour if there are no complications.

Laparoscopic appendectomy: This is very similar to the traditional open procedure and the difference being, instead of one incision 3-5 inches long, there are several incisions half an inch long. It is through these tiny incisions that the surgeon works, inserting a camera (laparoscope) through one incision and tiny instruments through two or more additional incisions. In one incision, the surgeon will introduce a nozzle to inflate the abdomen with carbon dioxide gas, allowing the appendix to be seen more easily. This allows the surgeon to look into a TV monitor and see inside the abdomen clearly for the removal of the appendix.

The surgeon identifies the appendix, then separates and cut the appendix, creating a line or sutures or by using a line of staples. The appendix is placed in a sterile bag that is removed by pushing through one of the incisions. This is to prevent any pus of infected appendix from escape into the abdomen. Again, the surgery ends with cleaning the area and closing the incisions. If, during a laparoscopic appendectomy, the surgeon discovers that the patient has peritonitis or ruptured appendix, a switch to an open surgery may be required.

According to a report published in April 2018 in the World Journal of Emergency Surgery, most surgeons worldwide choose the laparoscopic approach over open surgery in the treatment of both simple and complicated acute appendicitis. The laparoscopic procedure usually results in less pain, earlier recovery, shorter hospital stay and fewer complications such as surgical infections.


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Recovering after Appendectomy Surgery 

Patients can expect to leave the hospital one or two days after surgery and fully recover from the appendectomy after a few weeks. Nowadays, most of the laparoscopic procedures are done on an outpatient basis. Those who undergo open Appendectomy or experience additional complications (such as peritonitis), they may have to remain at the hospital for up to a week, and a drain may be needed.
Your doctor will likely give medication for mild pain, such as acetaminophen (Tylenol), oxycodone, or hydromorphone.

Here are some helpful tips for recovery:

  • Do not participate in strenuous activity or lift heavy objects for one week after a laparoscopic appendectomy, or for two weeks after an open appendectomy.
  • Support your abdomen (to avoid pain) with a pillow or other soft object when you laugh, cough, sneeze or make any other abdominal movements.
  • Don’t forget to wash your hands before and after touching the incision area.
  • Avoid wearing tight or rough clothing.
  • Some may also experience temporary constipation. Eating fiber-rich foods and Staying hydrated may help regulate the bowel movements.

The Bariatric and Laparoscopy department at Max Hospital is managed by Dr. Nikhil Agnihotri who is a highly qualified and accomplished consultant and Laparoscopic surgeon which includes laparoscopic appendectomy in India. The Department of Laparoscopic and Minimal Access surgery at Max Hospital is the first and prominent International centre of Excellence for Bariatric Procedures and Hernia Repair in Asia Pacific Region. They are considered as the best for Appendicitis Treatment New Delhi. Dr. Nikhil along with his highly skilled, qualified and dedicated team that comprises of 2300+ medical doctors offer quality care services across twenty nine specialities throughout network of fourteen hospitals.


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