Laparoscopic Appendix Surgery - Appendectomy

An appendectomy is a procedure done to remove your appendix. The appendix is a small, finger-shaped pouch that is attached to your large intestine on the lower right side of the abdomen. Though the function of an appendix is not fully understood, it is believed to play a role in the immune system by storing and protecting beneficial bacteria that help digest food. Here, let’s take a detailed look at appendectomy and when it is recommended.

An appendectomy is a surgical procedure to remove the infected appendix, which is called appendicitis. An appendectomy is performed in order to prevent complications from an infection of the appendix. An infected or inflamed appendix has the potential to rupture, and it is considered a medical emergency. Therefore, it is recommended that you get your appendix removed immediately in case of an infection.  

To remove the appendix, there are two types of surgery. An open appendectomy is a conventional or traditional method or procedure. Laparoscopic appendectomy is a minimally invasive technique with minimal pain and cuts, and it is more recent.

• Open appendectomy: An open appendectomy is a traditional method in which a larger incision is made, approximately 2 cm to 4 cm long, on the lower right-hand side of the belly or abdomen. The infected appendix will be removed by the surgeon, and the incision will be closed with stitches.
• Laparoscopic method: It is also called "keyhole appendectomy." The laparoscopic method is a newer technique with minimal cuts and pain to remove the infected appendix. 1-3 small incisions are made in the lower right side of the abdomen, or belly. Laparoscopic appendectomy employs smaller and fewer incisions; the procedure is performed with the help of a thin, long instrument called a laparoscope.

NOTE: The type of procedure chosen will depend on the severity of your condition. While mild cases can be managed with laparoscopic surgery, severe cases will require an open or conventional method. Your doctor will choose the course of treatment that is best for you. 

In the following cases, an appendectomy may be recommended.

• Appendicitis: Appendectomy is the primary surgical procedure to treat appendicitis. Appendicitis is a severe infection that can develop if bacteria and feces plug the opening of the appendix. This results in swelling and inflammation of the appendix.
• Sepsis: Your appendix could rupture if you do not get it treated early. In such cases, bacteria from your appendix could enter your bloodstream and lead to sepsis, a potentially fatal infection-related reaction.
• Peritonitis: The peritoneum, a thin layer of tissue covering your belly that mostly covers your belly and the majority of its organs, becomes inflamed in cases of peritonitis. In most cases, a bacterial or fungal infection is what causes the inflammation. An abdominal injury may result in infection. Peritonitis is a serious condition that can be fatal if not timely cured.
• Abscess: An abscess is a localized collection of pus that results from an infection. Abscesses that affect the appendix can indicate the need for an appendectomy.

What happens before the procedure? 

• Medical History: Your doctor will discuss your medical history, which includes your symptoms, other present ailments, and current medications or supplements, if any. 
• Medications: You might be asked to stop certain medications, such as blood thinners, for a brief period before and after the procedure in order to avoid complications such as bleeding.
• Allergies:  Make sure you inform your doctor about any allergies, such as allergies to latex or any medications.
• Quit Smoking: If you are a smoker, you will be asked to quit smoking for a certain period before and after the surgery, as it can delay healing. 
• Arrange for Help: Make sure that you arrange for a friend or a family member to help on the day of surgery and during your recovery.
• Antibiotic Treatment: After being diagnosed with appendicitis, your surgery can happen a few days later if your appendix hasn't ruptured. You will be given antibiotics intravenously to control the spreading infection. The antibiotic treatment can last up to 7 days before the surgery. This will help your surgeon get control of the spreading infection.

Note: If your appendix has ruptured, neither of these steps nor any pre-requisite safety measures will be followed; instead, you will be directly sent for surgery, as a  ruptured appendix can be fatal if not treated promptly.

 What happens during the surgery? 

• You will lie back, and anesthesia will be administered. You may be given spinal or general anesthesia. This will help make the procedure painless.
• A surgeon now makes a few tiny incisions near your belly button to access the appendix. 
• Your abdomen is inflated with carbon dioxide using a cannula, which is a tiny, narrow tube. This is done to improve vision during the procedure. 
• Your surgeon will now insert a laparoscope through one of the incisions. A laparoscope is a lengthy, narrow, flexible tube with an attached camera and light.
• The laparoscope helps the surgeon get a live view of the internal structures during the procedure by projecting the images onto a monitor.
• Once your surgeon gains access to the infected appendix, he/she will remove it with the help of surgical instruments.
• Finally, the incisions will be cleaned, closed, and dressed. 

What happens after the procedure?

• You may experience some pain and discomfort in the surgical area, which is normal. However, this can be managed with the prescribed medications.
• Your doctor will give you a clear set of instructions on how to take care of the incisions at home. Your doctor will brief you about the bathing process and ensure you do not wet the operated area. Keep your incision clean and dry.
• Have a healthy, fiber-rich diet and drink plenty of fluids in order to prevent constipation and avoid any associated complications.
• Normally, after a laparoscopic appendectomy, you can return home on the same day. You might need to stay in the hospital for a few more days if you have complications, such as an appendix burst. 
• Ensure that you arrange help on the day of the procedure and during your recovery, as you may need help with your everyday activities until you recover completely. 
• Follow all the post-surgical instructions given by your surgeon and attend the follow-up visits as instructed in order to achieve a fast and smooth recovery. 
• You should be able to get back to your normal activities within 4 to 6 weeks.

Though  appendectomy is a safe procedure, like any other surgery, it may also hold the possibility of certain complications or risks, such as the following: 

• Abdominal pain: In the first few weeks after the surgery, you might feel bloated, and experience chronic stomach aches and discomfort.  This pain usually goes away after the surgery. 
• Intestinal obstruction: After surgery, the intestines may become blocked or obstructed, leading to constipation, abdominal pain, and other complications.
• Constipation: Constipation is a condition in which the bowel frequency fluctuates and it becomes difficult to pass stools. This can be a potent complication after an appendectomy.
• Injury to surrounding organs: The appendix is located near other organs in the abdomen, and there is a risk of accidentally damaging or injuring these organs during the surgery.

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