Open Appendectomy Surgery - Appendix Removal : Procedure & Aftercare

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 advanced.
 

• 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 require an open or conventional method. Your doctor will choose the course of treatment that is best for you.

In the following cases, an open 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, leading to sepsis, a potentially fatal infection-related reaction.
• Peritonitis: Peritonitis is a serious medical condition characterized by inflammation and infection of the peritoneum, which is the thin membrane lining the abdominal cavity and covering the abdominal organs. It is usually caused by bacterial or fungal infections, but it can also occur due to chemical irritation, injury, or other underlying conditions.
• 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.

Read on to understand how an open appendectomy works:

How to Prepare For an Open Appendectomy?

• 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 you arrange for a friend or a family member to help on the day of surgery and during your recovery.
• Antibiotic Treatment: Based on the requirement, you might 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 before performing the surgery. This will help lower the chances of risks.

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 An Open Appendectomy?

Once you are ready for the procedure you may expect the following:

• You will be sent to the operating room and given a surgical gown to wear. 
• You will lie back, and anesthesia will be administered. You may be given general anesthesia. This will help make the procedure painless.
• Your lower abdomen area will be cleaned with an aseptic solution.
• Your doctor will make one large incision (2-4 inches) in your abdomen area. He/she will insert surgical instruments through the incision to separate the abdominal muscles and locate the infected appendix beneath. 
• In the event of an appendix rupture, the fluid and abscess accumulated in the abdominal cavity will be drained out. The abdomen will finally be cleaned off with saline solution.
• Once your surgeon gains access to the infected appendix, the surgeon will remove it with the help of surgical instruments.
• In the case of Peritonitis, your surgeon will leave the drainage tube inside your abdominal cavity to continue the drainage of fluids and abscesses. The tube might be left in place to be removed later.
• Finally, the incisions will be cleaned, closed, and dressed. 

What to Expect After an Open Appendectomy?

You may expect the following after an open appendectomy:

• You may experience some pain and discomfort in the surgical area, which is normal. However, this can be managed with prescribed medications.
• Your doctor will give you clear 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. 
• Have a healthy, fiber-rich diet and drink plenty of fluids in order to prevent constipation and avoid any associated complications.
• Normally, you can return home on the same day after a laparoscopic appendectomy. You might need to stay in the hospital for a few more days if you have any 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.

Here are some potential benefits of an open appendectomy:

• Accessibility and visualization: Open appendectomy provides direct access to the appendix and surrounding structures. This allows the surgeon to visually inspect the area, identify any abnormalities or complications, and ensure thorough appendix removal.
• Flexibility: The open approach allows the surgeon to adapt to different anatomical variations and complex cases. It is particularly advantageous when dealing with a ruptured appendix, extensive infection, or other intra-abdominal issues that may require additional surgical intervention.
• Appropriate for obese or pregnant patients: Open appendectomy is generally considered a suitable option for obese individuals or pregnant women, as it provides adequate exposure and access to the appendix, even in cases where the abdomen may be more difficult to access due to increased abdominal fat or a growing uterus.
• Lower risk of certain complications: While laparoscopic appendectomy is minimally invasive and associated with less post-operative pain, open appendectomy may have a lower risk of certain complications. For example, the risk of unintentional injury to other organs during the procedure may be lower with the open approach due to direct visualization and manual palpation.
• Familiarity and expertise: Open appendectomy has been performed for many years and is a well-established surgical technique. Surgeons who are more experienced in the open approach may feel more comfortable and confident performing this procedure, potentially leading to improved outcomes.

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: 

• Infection: There is a risk of developing a surgical site infection or infection within the abdominal cavity (intra-abdominal infection).
• Bleeding: During surgery, there is a possibility of bleeding, either from blood vessels within the abdominal cavity or from the surgical incision. 
• Incisional complications: The surgical incision made during open appendectomy carries a risk of complications, such as poor wound healing, scarring, or infection at the incision site.
• Injury to surrounding organs or structures: While rare, accidental injury to adjacent organs such as the intestines, bladder, or blood vessels can occur during the surgical procedure. 

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