Patient Education Partners in Your Surgical Care AMericaN COLLege OF SUrgeoNS DIVisioN OF EDUcatioN Appendectomy Surgical Removal of the Appendix Removal of the Appendix Patient Education This educational information is to help you be better informed about your operation and empower you with the skills and knowledge needed to actively participate in your care. Keeping You Informed Information that will help you Small intestine further understand your operation Appendix and your role in healing. Large intestine Education is provided on: Appendectomy Overview ................ 1 Treatment Options Expectations Condition, Symptoms, Tests ............ 2 Surgery Before your operation— Treatment Options ......................... 3 Evaluation usually includes Laparoscopic appendectomy—The blood work, urinalysis, and Risks and Possible Complications ..... 4 appendix is removed with instruments an abdominal CT scan, or Preparation and Expectations ......... 5 placed into small abdominal incisions. abdominal ultrasound. Your Your Recovery and Discharge ........... 6 Open appendectomy—The appendix surgeon and anesthesia Pain Control .................................. 7 is removed through an incision provider will review your health history, medications, Glossary/References ....................... 8 in the lower right abdomen. and options for pain control. Nonsurgical The day of your operation— Surgery is the only option for an acute You will not be allowed (sudden) infection of the appendix. to eat or drink while you The Condition are being evaluated for an Appendectomy is the surgical removal Benefits and Risks emergency appendectomy. of the appendix. The operation is An appendectomy will remove the Your recovery—If you done to remove an infected appendix. have no complications you An infected appendix, called infected organ and relieve pain. Once the appendix is removed, appendicitis usually can go home in 1 or appendicitis, can burst and release 2 days after a laparoscopic bacteria and stool into the abdomen. will not happen again. The risk of not having surgery is the appendix or open procedure. What are the common symptoms? can burst resulting in an abdominal Call your surgeon if you are infection called peritonitis. in severe pain, have stomach Abdominal pain that starts Possible complications include cramping, a high fever, odor around the navel or increased drainage from abscess, infection of the wound Not wanting to eat or abdomen, intestinal blockage, your incision, or no bowel Low fever hernia at the incision, pneumonia, movements for 3 days. Nausea and sometimes vomiting risk of premature delivery (if Diarrhea or constipation you are pregnant), and death. This first page is an overview. For more detailed information, review the entire document. AMericaN COLLege OF SUrgeoNS • 633 N. SaiNT CL air ST. • CHicago, IL 60611 • WWW.FACS.ORG 1 Appendectomy The Condition, Signs and Symptoms, and Diagnostic Tests The Keeping You Condition Informed The Appendix Appendix Small intestine Appendicitis Pain The appendix is a Pain can be different for each small pouch that person because the appendix hangs from the can touch different organs. This large intestine can be confusing and make it where the small difficult to diagnose appendicitis. and large intestine join. If the Most often pain starts around appendix becomes the navel and then moves to Large blocked and the right lower abdomen. The intestine swollen, bacteria pain is often worse with walking Appendix can grow in the or talking. During pregnancy, pouch. The cause of the appendix sits higher in the infection can be from an abdomen so the pain may seem illness, thick mucus or hard stool to come from the upper abdomen. trapped in the opening of the appendix, Common In the elderly, symptoms are or parasites. often not as noticeable because Diagnostic Tests there is less swelling.1,2 Appendicitis History and Physical Appendicitis is an infection of the The focus will be on your abdominal pain. Upper appendix. The infection and swelling can Right Left decrease the blood supply to the wall of Tests (see glossary) the appendix. This leads to tissue death, Abdominal ultrasound—checks and the appendix can rupture or burst for an enlarged appendix causing bacteria and stool to release into Computed tomography (CT) scan—checks Right Left the abdomen. This is called a ruptured for an enlarged appendix and infection appendix. A ruptured appendix can Complete blood count (CBC)—a Lower lead to peritonitis, which is an infection of your entire abdomen. Appendicitis blood test to check for infection Other medical disorders have affects 1 in 1,000 people, most often Rectal exam—checks for tenderness on symptoms similar to appendicitis, between the ages of 10 and 30 years old. the right side and for any rectal problems such as inflammatory bowel It is a common reason for an operation that could be causing the abdominal pain in children, and it is the most common disease, pelvic inflammatory Pelvic exam—may be done in surgical emergency in pregnancy. disease, gastroenteritis, urinary young women to check for pain tract infection, right lower Appendectomy is the surgical from gynecological problems like lobe pneumonia, Meckel’s removal of the appendix. pelvic inflammation or infection diverticulum, intussusception, Urinalysis—checks for an and constipation. Symptoms infection in your urine, which can cause abdominal pain Stomach pain that usually starts Electrocardiogram (ECG)—sometimes around the navel and then often moves done in the older adult to make sure to the lower right side of the abdomen. heart problems are not the cause of pain Loss of appetite Low fever, usually below 100.3°F Nausea and sometimes vomiting Diarrhea or constipation 2 AMericaN COLLege OF SUrgeoNS • 633 N. SaiNT CL air ST. • CHicago, IL 60611 • WWW.FACS.ORG AMericaN COLLege OF SUrgeoNS • 633 N. SaiNT CL air ST. • CHicago, IL 60611 • WWW.FACS.ORG Appendectomy Surgical and Nonsurgical Treatment Surgical Treatment An operation is the only option for Keeping You acute infection of the appendix. Informed Laparoscopic Appendectomy Laparoscopic versus Open Appendectomy Laparoscopic versus Open Appendectomy Conversion Rates This technique is the most common LaparoscopicLaparoscopic Appendectomy Appendectomy OpenOpen Appendectomy Conversion rates from a for simple appendicitis. The surgeon laparoscopic to an open will make 1 to 3 small incisions in the procedure average 110 per 1,000 abdomen. A port (nozzle) is inserted patients.2 Conversion to an open into one of the slits, and carbon technique is most commonly dioxide gas inflates the abdomen. This due to adhesions (bands of process allows the surgeon to see the scar-like tissue sticking on appendix more easily. A laparoscope organs), followed by perforation is inserted through another port. It (bursting) and peritonitis.3,4 looks like a telescope with a light and camera on the end so the surgeon Pediatric Considerations can see inside the abdomen. Surgical There is no reported difference instruments are placed in the other in the length of hospital stay small openings and used to remove for laparoscopic versus open the appendix. The area is washed with procedures for nonruptured (2.3 sterile fluid to decrease the risk of versus 2.0 days) and ruptured further infection. The carbon dioxide Endoloop used to Anterior cecal artery (5.5 versus 6.2 days) appendices.5 comes out through the slits, and then the manipulate and position appendix Ileum sites are closed with sutures or staples Ruptured Appendix or covered with glue-like bandage and Ascending colon Unfortunately, many people do steri-strips. Your surgeon may start Appendicular artery not know they have appendicitis with a laparoscopic technique and until the appendix bursts. If need to change to an open technique. Appendix this happens, it causes more This change is done for your safety. serious problems. The incidence Open Appendectomy of ruptured appendix is 270 Endoloop used to per 1,000 patients. This is The surgeon makes an incision about 2 manipulate and position appendix higher in the very young and to 4 inches long in the lower right side Appendix stapled very old and also higher during of the abdomen and cuts through fat pregnancy because the symptoms and muscle layers to the appendix. The (nausea, vomiting, right-sided appendix is removed from the intestine. pain) may be similar to other The area is washed with sterile fluid to pregnancy conditions.1,7 decrease the risk of further infection. A small drainage tube may be placed going from the inside to the outside of the abdomen. The drain is usually removed in the hospital. The site is Appendix stapled closed with sutures or staples or covered with glue-like bandage and steri-strips. Removal of appendix Nonsurgical Treatment If you only have some of the signs of appendicitis, your surgeon may monitor you to see if the symptoms get any worse. If you have an abscess (a collection of pus), your surgeon may treat you with antibiotics first and may have you come back for elective surgery in 4 to 6 weeks. Removal of appendix AMericaN COLLege OF SUrgeoNS • 633 N. SaiNT CL air ST. • CHicago, IL 60611 • WWW.FACS.ORG AMericaN COLLege OF SUrgeoNS • 633 N. SaiNT CL air ST. • CHicago, IL 60611 • WWW.FACS.ORG 3 Appendectomy Risks of This Procedure Your surgeon will do everything possible to minimize risks, but appendectomy, like all operations, has risks. The Risk What Happens Keeping You Informed Infection For simple acute appendicitis, wound infection Antibiotics are typically given right before is reported as 0 to 34 per 1,000 patients for the operation. Your health care team should laparoscopic and 1 to 70 per 1,000 for open wash their hands before examining you. procedures. The risk increases for a perforated appendix and abdominal infection.2,3,8-11 Abscess An abscess is reported as 0 to 24 per Call your surgeon if your wound is red or draining 1,000 patients for laparoscopic and 0 to pus. Antibiotics are used to treat an abscess.