Appendectomy, appendicitis

Anatomy and Physiology (What is the appendix and what does it do?)

The appendix is a blind-ending tube that comes off of the first part of the colon, the cecum. In fact, the appendix resembles a worm arising from the colon, hence its full name vermiform appendix which in Latin means worm.

The appendix has no known function. It is believed that it may have a role in the immune system.

Since the appendix is a dead-end tube, stool can get trapped in it. Trapped stool is called a fecalith. As a result of the fecalith, the appendix can become inflamed and appendicitis develops. If the inflammation persists, the appendix is at risk for rupture.

Who is at risk?

There are no preventable risk factors for appendicitis. Some studies have suggested that appendicitis runs in families.

How is it diagnosed?

Appendicitis classically starts as pain in the lower right side of the abdomen. Sometimes, the pain starts at the belly button before it moves to the right. People afflicted with appendicitis almost never have an appetite. Fever, nausea, and vomiting can also accompany the pain. To confirm diagnosis, your doctor may get a CAT scan of your abdomen especially if your symptoms are not classic. With women it is important to rule out a gynecologic cause for the pain that does not require surgery such as simple ovarian cysts or a sexually transmitted disease.

If your doctor suspects appendicitis, bloodwork will also be taken. An elevation in the number of infection-fighting cells, the white cells, can also confirm the diagnosis of appendicitis.

How do you prepare for surgery?

In most cases, an appendectomy is considered emergent surgery to prevent rupture of the appendix and spread of infection. Surgery usually is scheduled once the diagnosis is made, most often within 24 hours. Antibiotics are often given first while waiting for an available operating room.

Surgical Procedure

The appendix can be taken out via a small abdominal incision, the open procedure, or by a camera and instruments inserted via multiple small incisions, the laparoscopic procedure. Safety of the operation, pain, and recovery time is fairly similar for both procedures. With the open procedure, a three inch horizontal or diagonal incision is made in the right lower quadrant of the abdomen overlying the appendix. With the laparoscopic approach, 3-4 0.5 inch incisions is made in the belly button, the pubis, and on the left side of the abdomen. The appendix is freed from the cecum and cut at its base. The abdomen is washed out with sterile fluid to reduce the risk of infection.

The most common complication of an appendectomy is an infection in your incision. A wound infection generally occurs approximately five days after surgery. An infection is usually characterized by redness, warmth, and increased tenderness around the incision. In some cases, you may develop a significant fever. One of the most serious complications arising from an appendectomy is a deeper infection in your abdomen called an abscess. Signs of an abscess include fever and abdominal pain. An abscess requires an admission into the hospital for intravenous antibiotics. Placement of a drainage catheter from the skin into the abdomen to evacuate the infection is the preferred treatment. In rare cases, a repeat operation may be necessary to completely clear out the infection.

Another common complication is urinary retention. Some people will find after surgery that they are unable to pee. This is a side-effect of the anesthesia medication used to put you to sleep for surgery. This usually resolves within 24 hours. If you have a lot of discomfort from the pressure in your bladder, a small catheter will be inserted into your bladder to drain the urine. In rare cases, urinary retention lasts for as long as a week, usually with older men. In that case, a urinary catheter will be left in and attached to a small leg bag that fits underneath your pants. You can go home with a leg bag. Your surgeon will schedule a follow-up appointment usually a week from discharge to have the bag removed.

One last risk of abdominal surgery is that of a small bowel obstruction. Scar tissue often forms after surgery. When the scar tissue entraps a piece of floating small bowel, it causes a blockage. 2/3rds of the time, with complete bowel rest and bowel de-compression, the bowel will unkink itself. The remaining 1/3rd of the time, an operation will be needed to relieve the blockage.

After surgery, you may wake up with a catheter in your bladder. This is usually removed in the recovery room. You will be allowed to have liquids and solid food when you feel able. Early ambulation is encouraged. Most patients are discharged the day after surgery. If the appendix was ruptured or very close to rupturing, your surgeon may opt to keep you in the hospital for an additional day for intravenous antibiotics.