What is appendicitis?
The appendix is a tubular structure which comes off the caecum at the start of the large intestine. It is located in the right lower part of the abdomen and has no recognized function in adults.
Inflammation of the appendix (called appendicitis) occurs when appendix results from blockage of the lumen of the appendix. It is a surgical emergency and although early appendicitis may respond to antibiotics, the gold standard is to remove the appendix (or perform an appendicectomy).
What does the procedure involve?
The appendix is usually removed laparoscopically (key-hole surgery). A small incision is made around the umbilicus where a 12mm camera port is introduced. Two 5mm ports are inserted through two smaller incisions in the lower abdomen – one on the left side and the other in the midline.
The appendix blood vessels are controlled and divided followed by controlling the base of the appendix with a tie of suture material called PDS. The appendix is then divided and removed in a plastic bag (Endocatch) through the umbilical port. It is sent to the pathology laboratory to be analysed and looked at under the microscope. This is to confirm the diagnosis of appendicitis and rule out any incidental findings such as tumours.
If the appendix is ruptured because of the infection, there may be pus inside the abdomen which is removed and a washout is performed. Sometimes a drain tube is placed to remove any residual wash fluid, blood or pus.
The fascial cut at the umbilical port site is closed. Local anaesthetic is injected and the skin is closed with dissolving suture material.
What are the risks of surgery?
Appendicectomy is a very safe procedure and is one of the most commonly performed general surgical operations. However, any procedure carries some risk.
Surgical procedural risks can be divided into anaesthetic and surgical risks.
Anaesthetic risks are usually discussed with the patient by the anaesthetic team.
Surgical risks specific to appendicectomy include: bleeding from the appendiceal vessels, infection of the wound or inside the abdomen, bowel damage and conversion to open surgery.
Appendicitis is a surgical emergency and you will be admitted to hospital usually through the emergency department with abdominal pain.
You will need to be fasting for at least 6 hours from food and at least 4 hours from water or other clear fluids in order to have a safe anaesthetic.
A normal diet is resumed as tolerated from day one. However, if the appendix was ruptured, it can take longer for bowel function to resume normally and a liquid diet or a light diet may be required for the first day.
Dressings are usually in two layers – Steristrips with a padded-Opsite on top.
These are waterproof so you can shower but cannot swim or have a bath.
Dressings stay on for 5-7 days. Once the top dressing comes off, leave the Steristrips on for a few more days until they start to peel off by themselves.
You should avoid any heavy lifting or straining for 6 weeks after surgery to avoid an incisional hernia at the umbilical port.
Patients can usually go home the day after their appendicectomy unless the appendix was ruptured.
In case of a ruptured appendix, the patient may need to stay in hospital for a few days of intravenous antibiotics or until the drain is removed.
A wound review by your surgeon or local doctor is advisable 1-2 weeks after surgery.
The appointment is usually made for you by the ward clerk before leaving the hospital.
At your follow-up appointment, your wounds are checked and pathology of the appendix is discussed.