Appendicectomy

What is it?
Appendicectomy is a surgical procedure that is performed to remove the appendix from the abdomen, which can either be an open surgical procedure (traditional method) or via laparoscopic procedure (keyhole surgery).

The appendix is a tiny, finger-shaped pouch of the intestine that extends from the caecum that is the first part of the large intestine and is found in the right lower quadrant of the abdomen. 

A blockage within the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, inflicting the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture. When the appendix becomes inflamed, it’s painful and if it ruptures (perforated appendix), it will leak infected fluid into the abdomen that causes peritonitis, which may be fatal.

Symptoms
Some of the symptoms exhibited by a patient suffering from appendicitis are:

• Sudden pain in the lower abdomen, usually on the right side
• Sudden pain that begins around the navel, shifting to the lower right abdomen
• Pain that worsens when coughing, walking or making other jarring movements
• Nausea
• Loss of appetite
• Low-grade fever, which worsens as the illness progresses
• Constipation or diarrhea
• Abdominal bloating
• Inability to pass gas

Diagnosis

The doctor will conduct the following diagnostic tests to confirm appendicitis:

• Urine tests
• Blood tests. An increase in the white blood cell count can indicate the presence of infection
• Abdominal x-ray
• CT scan

Procedure

The surgeon will decide the type of medical procedure depending on the severity of appendicitis. The surgeon will decide on the procedure after discussing the options with the patient. The two main procedures are:

• Open appendectomy  
  The traditional surgical technique for removing an inflamed appendix is making an incision in the lower right side of the abdomen. The muscle layers are separated and the appendix is found and removed. The muscle layers and skin are then sewn back together using the dissolvable stitches.  A tiny tube may be put in the incision to drain out fluids.
• Laparoscopic appendectomy
  This "keyhole" surgical technique involves creating a couple of tiny incisions in the abdomen and inserting a laparoscope, a fine and slim flexible tube with a small camera at its tip, through one of the incisions and surgical instruments through the other incisions. 

The laparoscope permits the surgeon to visualize the inside of the abdominal cavity on a TV screen. The abdominal cavity is inflated with CO2 gas to allow the surgeon to clearly see the area. The surgeon uses the laparoscope to find the appendix and the surgical instruments to remove it.  The tiny incisions in the abdomen are closed using stitches or small paper tapes and are covered by sterile, waterproof dressings.  

Antibiotics are usually given before and/or during surgery and can also be given after surgery. The antibiotics may be taken orally as liquid or tablets, or intravenously through a drip in the hand or arm (especially if the appendix has ruptured or peritonitis has developed).

Post Procedure

The doctor might suggest the following measures to follow after the procedure:

• Follow the dietary advice provided
• Ingestion of a mild laxative for the first couple of days.
• Drink plenty of water every day to prevent constipation.
• Have adequate rest.
• Avoid lifting heavy objects and stair climbing, so as not to strain the abdominal muscles.
• Slowly resume your normal activities after a few days.
• Include regular, gentle exercise.

Risk

• Bleeding
• Infection
• Damage to surrounding structures in the abdomen