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Appendix removal (appendicectomy)

Published by Bupa's health information team, February 2009.

This factsheet is for people who are planning to have their appendix removed, or who would like information about it.

Appendicectomy (or appendectomy) is an operation to remove the appendix. The appendix is a small 'blind-ending' tube attached to the large bowel (colon) and is located in the lower right side of your abdomen.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About appendicitis
Preparing for your operation
About the operation
What to expect afterwards
Recovering from appendix removal
What are the risks?
Questions and answers
Related topics
Sources

About appendicitis

The appendix can become swollen as a result of infection or obstruction (called appendicitis). Symptoms of appendicitis include pain in the lower right side of the abdomen, high temperature and vomiting. Prompt surgery is needed to remove the appendix. If not treated properly, bowel infection (peritonitis) can result often from a 'burst appendix' requiring surgery and prolonged treatment.

Preparing for your operation

Appendicectomy usually requires a hospital stay of up to two days and is done under general anaesthesia. This means you will be asleep during the operation. You will be asked not to eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

Your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

If the operation is being done on a child, you will be asked to sign the consent form if you have parental responsibility for the child. People with parental responsibility are usually, but not invariably, the child's birth parents. Your child may wish to sign this form too. In some circumstances a child can sign their own consent form independently, providing he or she understands what they are being asked to do.

About the operation

The operation usually takes 30 to 45 minutes depending on the technique used.

Laparoscopic (keyhole) surgery

Two or three small cuts are made on your lower abdomen. Your surgeon will insert a camera into the abdomen to view the appendix. The appendix is removed using special instruments passed into the abdomen. The skin cuts are closed with dissolvable stitches.

Open surgery

A single cut is made in the lower abdomen usually on the right side and the appendix is removed. The cut is closed with stitches.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off. You may have a drip in your arm to keep you hydrated and give you painkillers and antibiotics.

When you feel ready, you can begin to drink and eat, starting with clear fluids.

You may have a fine tube (catheter) fitted to drain urine from your bladder into a bag. This will usually be removed when you are ready to get out of bed and walk around.

Your surgeon will visit you to assess your progress and answer any questions you may have about the operation.

Your nurse will give you advice about getting out of bed, bathing, diet and gentle exercises.

When you are ready to go home, you will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Dissolvable stitches will disappear in seven to 10 days. Non-dissolvable stitches are removed seven to 10 days after surgery.

Recovering from appendix removal

If you need pain relief, you may take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.

It may take four weeks or longer before you fully recover, but often it's shorter.

An infection can develop either in your wound or deeper in the abdomen. Contact your GP if you develop any of the following symptoms:

increasing pain or pain that can't be controlled with painkillers
high temperature, sweating or shaking
discharge from the wound

What are the risks?

Appendicectomy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.

Side-effects of appendicectomy include:

soreness, swelling and bruising - this can last up to four weeks
scarring - you will have a permanent scar, this usually fades gradually over time

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications specific to appendicectomy are uncommon but can include:

infection - antibiotics can help treat infection
unusual red or raised scars (keloids) - these can take years to improve
scar tissue formation - this may affect the bowel in later years sometimes leading to bowel obstruction
hernia formation - rarely, a hernia can occur at the surgical site

If you are having keyhole surgery, there is a chance your surgeon may need to convert your keyhole procedure to open surgery.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.