Appendicectomy

What is the appendix?

The appendix is a small tube attached to the caecum (large bowel). It can vary from 2-10cm in size and usually lies in the right lower side of the abdominal cavity. The appendix has no known function in humans.

What is appendicitis?

Inflammation of the appendix may result from a blockage of the appendix tube and/or infection. The pain is often initially described in the centre of the abdomen before moving to the right side as the inflammation progresses. Patients often report vomiting and a lack of appetite.

How is it diagnosed?

Often the symptoms and the clinical examination alone are enough to support a diagnosis of appendicitis. Blood tests will confirm an inflammatory or infective process. Ultrasound can be useful in unclear cases and helps to exclude other causes of pain in the area such as a ruptured ovarian cyst. CT scans are not often used, but will confirm the diagnosis in complex situations.

How is it treated?

It is standard practice to remove the appendix. If it is left, there is a risk of perforation or abscess formation. Removing the appendix also leads to a rapid resolution of symptoms.

What happens prior to surgery?

Blood tests and a heart tracing (ECG), maybe required before surgery. The surgeon will go through the procedure with you and take your consent. The anaesthestist will also visit to discuss the general anaesthetic and your post surgery pain relief.

How is it performed?

The majority are performed through a keyhole approach. You will be under a general anaesthetic and unaware of the procedure. Three small cuts are made and the appendix is removed through a 1cm cut beneath the belly button. In more complex cases a cut may be made over the appendix area and the surgery performed as an open procedure. Recovery time can be longer in these situations.

How long will it take for me to recover from surgery?

Most patients feel more comfortable immediately after the procedure as the appendix has been removed. Regular painkillers are used initially and will be required for 3-5 days. Occasionally patients go home the same day, but it is more common to spend one night in hospital. You will be discharged once you are fully mobile, passed urine and comfortable. Some patients require 2-3 days in hospital for antibiotics if the appendix has perforated. Patients can return to work after a week, but it will depend on the severity of the appendicitis and your occupation. Dissolvable sutures are usually used so will not need to be removed.

Which medications will I require after surgery?

You will be discharged from hospital with a supply of simple painkillers with instructions on how to use them. Regular paracetamol is particularly effective and can be combined with an anti-inflammatory drug (ibuprofen) or a codeine based drug (dihydrocodeine). Anti-inflammatories are not suitable for all patients and should be taken with food. The codeine-based drugs can cause constipation and should be taken with plenty of fluids. Most patients do not require painkillers after 5 days.

When can I return to normal activities?

There are usually no restrictions on lifestyle or activities after a hernia has been repaired once recovery is complete. Strenuous activities (gym) should be avoided for 6 weeks.

When can I drive?

Driving should be avoided in the first week after surgery. Once you can perform an emergency stop in a stationary vehicle and turn to view your blind spot then driving should be safe. It is preferable to contact your insurance company to check for any specific instructions they may have.

What are the risks?

Straightforward removal carries a very low risk. Wound infections can occur and are due to the removal of an infected appendix through the skin. Pain, swelling and redness may indicate wound infection and your consultant should be informed.

Who do I contact if there are concerns?

The group practice telephone is answered in working hours and messages can be left out of hours. Any concerns will be relayed directly to one of the consultant surgeons on receipt. The hospital ward also provides a 24/7 means of contact. They will contact the consultant about any concerns and are able to give advice if required.