Appendicectomy at Leeds Hospital

What is an appendicectomy?

An appendicectomy is an operation to remove your appendix, a small, finger-shaped pouch attached to your large bowel on the lower right side of your tummy. It's the standard treatment for appendicitis, when the appendix becomes swollen, infected, or bursts.

What conditions does it treat?

An appendicectomy is used to treat:

• appendicitis, where the appendix is inflamed or infected
• an appendix mass, where a lump has formed around an inflamed appendix
• a burst (ruptured) appendix, including any infection or abscess this has caused.

What are the benefits of having an appendicectomy?

Removing an inflamed appendix treats the underlying infection and prevents it from bursting, which can lead to serious complications such as peritonitis (infection of the lining of the tummy) and blood poisoning. Where keyhole surgery is possible, patients tend to have less pain after the operation, spend less time in hospital, return to normal activity sooner, and are left with smaller scars than with open surgery.

Are there different types of surgical approaches?

• Keyhole (laparoscopic) surgery: the most common approach today, using a few small cuts, a camera, and long instruments to remove the appendix.
• Open surgery: uses one larger cut and is used when keyhole surgery is not suitable, for example if the appendix has burst, is severely inflamed, or you have scar tissue from earlier operations. Surgeons sometimes need to change from keyhole to open surgery partway through the surgery. This is a safety decision, not a complication.
• Antibiotics instead of surgery: for some people with straightforward appendicitis, a course of antibiotics can be tried instead of an immediate operation, although some people go on to need surgery later.
• Treating an appendix mass: if a lump has formed around the appendix, your surgeon may delay surgery for a few weeks and treat you with antibiotics first, sometimes alongside a small drain placed under local anaesthetic to remove infection or pus. You would then be seen in clinic a few weeks later to plan the next step.

What happens before the operation?

• You may need repeat assessments or scans if your diagnosis is not certain, since appendicitis can be difficult to confirm from symptoms alone
• You see a surgeon, who explains the operation, and an anaesthetist, who checks your general health and explains the anaesthetic
• You tell your team about any health conditions, allergies, and medicines you take
• You are told when to stop eating and drinking (fasting) before your operation
• You arrange for someone to collect you afterwards, and to stay with you overnight if you go home the same day
• You sign a consent form to confirm you understand the operation and agree to it.

What happens during the procedure?

1. You're given a general anaesthetic, so you're asleep and feel no pain throughout.
2. For keyhole surgery, your surgeon makes a few small cuts in your tummy, usually three, and fills your tummy with gas to create room to work.
3. A thin tube with a camera and light (laparoscope) lets your surgeon see the operation on a screen, while long, narrow instruments passed through the other cuts are used to free and remove the appendix.
4. If your appendix has burst, is very inflamed, or scar tissue makes keyhole surgery unsafe, your surgeon changes to open surgery, using one larger cut in the lower right or middle of your tummy to reach and remove the appendix.
5. If there is an abscess, this is drained and washed out, and a small drainage tube may be left in for a few days.
6. Your wound is closed with stitches, staples, or surgical glue, and you're taken to a recovery area to wake up under observation.

What does recovery look like?

In hospital

You wake up in a recovery area where you're monitored, before being moved to a ward or day-case area. You can usually drink soon after the operation and eat once you feel hungry, and you can get out of bed as soon as you feel able, although you may feel drowsy for a day or so.

If your appendix had not burst, you can usually go home the same day or the day after. You'll need to be eating and drinking without feeling sick, have had your wound checked, and be able to manage your pain with tablets. A ruptured appendix, or a more serious infection such as peritonitis, may mean a longer stay in hospital.

If you go home the same day, you need a responsible adult (someone over 18) to collect you and stay with you overnight.

At home

• Any skin glue is left to flake off by itself after 7–10 days rather than picked at; dressings are only changed if they get soaked
• Dissolvable stitches do not need removing; you'll be told if yours need to come out
• The wound can feel tingly, numb, or itchy, and a hard lump can form as scar tissue grows; this is a normal part of healing
• It's common to have some pain for several days, which regular pain relief can ease
• After keyhole surgery, you may get shoulder pain caused by the gas used during the operation, which settles as your body absorbs the gas and you move around more
• A sore throat from the breathing tube used during anaesthetic usually clears within 1–2 days
• Changes to your bowel habits, such as constipation or loose stools, are common; eating more fibre and drinking plenty of fluids can help, and your team may suggest a short course of a mild laxative too
• For at least 24 hours after a general anaesthetic, avoid driving, operating machinery, making important decisions, or signing legal documents.

If you have a desk job, you may be able to return to work after about a week. If your job is more physical, you may need to wait 2 to 4 weeks. Your surgeon will advise you on what's right for your recovery.

What are the risks and complications?

• Pain, bleeding or bruising
• Infection in the wound, tummy or chest, often showing as redness, swelling or tenderness around the wound, most commonly 4–5 days after surgery
• Reaction to anaesthetic
• Finding that your appendix was normal and something else was causing your symptoms
• Rarer risks: injury to nearby organs such as the bladder or bowel, a hernia, temporary difficulty emptying your bladder, bloated bowels (ileus), or a blood clot in the legs or chest
• With keyhole surgery specifically: injury to internal structures, or gas collecting under the skin
• An abscess forming after surgery if your appendix was severely inflamed, which may need further treatment
• If your appendix had burst, a risk of peritonitis (inflammation of the lining of the tummy)

Most complications are uncommon, and your surgical team will discuss your individual risks with you before the operation.