Appendectomy is a surgical procedure that removes the appendix to treat appendicitis.
The appendix is a small pouch-like organ that projects from the cecum in between the small and large intestines. Health experts tend to disagree on the purpose of the organ with some saying it helps in the body’s immunity while others believe it is a useless proof of human evolution.
Like any other organ in the body, the appendix can become infected, causing a condition known as appendicitis or the inflammation of the appendix. This condition may be treated with antibiotics. However, in the majority of cases, surgery, which can be open or minimally invasive, is the only solution. People who have undergone the procedure are able to recover quickly and live normal, healthy lives.
As mentioned earlier, appendix removal is performed on individuals diagnosed with appendicitis, which is the inflammation of the appendix caused by an infection or bacteria that affect the organ’s tissues. It can also be due to the presence of stool that promotes bacterial growth.
As these bacteria continue to destroy the organ, the appendix develops pus and the tissue become necrotic (death of the tissue) that it can rupture, spreading the infection to other parts of the body, which then becomes life threatening.
Signs and symptoms of appendicitis, such as fever, nausea, and vomiting, manifest gradually. But one of its classic signs is abdominal pain, which can begin around the belly button area and moves to the lower right quadrant where the appendix is located.
Appendicitis can occur at any age although it is more common with children who are ten years and older. It can also happen among pregnant women, in which case the condition is considered life-threatening and, therefore, an emergency.
Before the surgery is performed, the doctor, who may be an internist for adults and a paediatrician for children, will perform a series of tests to confirm the diagnosis and plan the operation. Some of the common examinations include a rectal exam, complete blood count (CBC), and abdominal ultrasound.
The tests are essential as the symptoms may be caused by other conditions including ulcers.
The imaging tests can also be helpful in determining whether the appendix has already ruptured. If not, the doctor has the option to take a more conservative approach by draining the abscess first through an attached tube to the abdomen and wait for at least 8 weeks before the surgery is done. However, if tests confirmed that the situation is severe, both drainage and appendectomy are performed immediately.
However, it’s possible for the doctor to discover the perforation during the actual surgery wherein drainage happens before the procedure ends.
The appendix removal can be approached in two ways: open and minimally invasive. In open surgery, the surgeon makes one small incision in the abdominal area where the appendix is found and remove it with surgical tools. In a minimally invasive surgery, three to four small incisions are made in the area where the appendix is located, and a laparoscope, a long narrow tube with a camera, is inserted in one of these incisions to see the condition of the appendix and the surrounding organs. Once the surgeon has determined the actual state, size, and location of the appendix, he can proceed with the removal by inserting surgical instruments through the remaining incisions. Laparoscopic appendectomy can be done even if there’s perforation discovered during an appendectomy.
In both types of surgery, the patient is given a spinal anaesthesia with sedation or a general anesthesia and is advised to stay in the hospital for few days for close monitoring.
It is expected that the patient will feel discomfort and pain in the abdomen, which can be controlled with pain relievers. Appendix removal may also lead to an infection, perforation or bleeding of the bowel, and sepsis or systemic inflammation of the body (although this is extremely rare). In some cases, patients may experience stump appendicitis, which occurs if the appendectomy left a portion of the organ, in which case, the procedure is repeated.
Wolfe JM, Henneman PL. Acute appendicitis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Elsevier Mosby; 2009:chap 91.
Howell JM, Eddy OL, Lukens TW, et al. American College of Emergency Physicians. Clinical policy: Critical issues in the evaluation and management of emergency department patients with suspected appendicitis. Ann Emerg Med. 2010;55:71-116.