Appendix Surgery

The vermiform appendix is a worm-shaped, blind-ended tubular structure connected to the cecum, a pouchlike structure of the colon, located at the junction of the small and the large intestines.

The vermiform appendix is removed because of appendicitis, which is the inflammation of appendix due to infection and other causes. 

While there can also be multiple causes for one case of appendicitis, in many cases, the cause of appendicitis is unknown. Experts believe an obstruction,  either partial or complete, in the appendix, may cause appendicitis. Obstruction is often due to the collection of fecal matter and can also be the result of:

• enlarged lymphoid follicles
• worms
• trauma
• tumors

When there’s an obstruction in the appendix, bacteria can multiply inside the organ, leading to the formation of pus that increases the pressure and can be painful and can also compress local blood vessels, causing gangrene. If the appendix ruptures, fecal matter can fill the abdomen, leading to a medical emergency.

Appendectomy is the surgical removal of the appendix and is most often performed as an emergency operation. 

There are two types of appendectomies.  Open appendectomy and laparoscopic appendectomy. The type of surgery the doctor chooses depends on several factors, such as the severity of appendicitis and the patient's medical history.

• Open Appendectomy

In this type of surgery, a surgeon makes one incision in the lower right side of the abdomen. The appendix is removed. The wound is closed with stitches. This procedure allows the surgeon to clean the abdominal cavity if the patient's appendix has burst.

• Laparoscopic Appendectomy

In this type of surgery, a surgeon accesses the appendix through a few small incisions in the abdomen. The cannula, a small, narrow tube, will then be inserted and used to inflate the abdomen with carbon dioxide gas which allows the surgeon to see the appendix more clearly. The laparoscope, a long, thin tube with a high-intensity light and a high-resolution camera at the front, is inserted through the incision. When the appendix is found, it is tied off with stitches and removed and small incisions are then cleaned, sealed, and dressed. Laparoscopic surgery has a shorter recovery time. 

The doctor may go for an open appendectomy if the patient's appendix has burst and the infection has spread to other organs. Open appendectomy is also the preferred option for people who had had abdominal surgery in the past.

General anesthesia is commonly used during the surgery. 

The surgery is performed under general anesthesia and because of that, the patient is completely unconscious and doesn't feel any pain.

Appendix removal is a fairly simple and common procedure, but there are some risks associated with it, including:

• bleeding
• infection
• injury to nearby organs
• blocked bowels

You will stay in the hospital one to three days after the operation but may be able to go home the same day as the surgery if the appendicitis wasn’t a severe one. In cases where you are leaving on the same day, a family member or friend will need to take you home as you would have most likely received general anesthesia whose effects take several hours to wear off. 
The patient's release will depend on:

• Patient's overall physical condition
• The type of appendectomy performed
• The body’s reaction to the surgery

In the days following the appendectomy, the patient may feel moderate pain in the areas where incisions were made. The pain or discomfort, if any, should improve within a few days. The patient should also watch for signs of infection, which include:

• redness and swelling around the incision
• fever above 101°F
• chills
• vomiting
• loss of appetite
• stomach cramps
• diarrhea or constipation that lasts for more than 2 days

The cost of an appendectomy in India can be anywhere in between INR 60,000 and INR 5,00,000.

A surgical procedure performed to remove an infected appendix is known as appendectomy or appendix surgery.

The appendix is a small finger-shaped tube or pouch, which is about four inches long. It is present at the junction of the small intestine and large intestine and is usually present in the lower right side of the stomach. The function of the appendix is not known.

An appendix surgery is usually needed when the appendix develops an infection known as appendicitis.
Appendicitis is a painful condition.
Appendicitis is considered to be a medical emergency as the appendix may burst or rupture and allows any contents carrying the infection to enter the abdominal cavity.
It is therefore important to remove the appendix before it gets ruptured to prevent any future complications.

The following symptoms may be seen in the case of appendicitis and may need an appendix surgery:

• Sudden pain starting at the right side of the lower stomach
• Sudden pain starting around the belly button area and shifting to the lower right stomach region
• Pain that becomes worst on walking, coughing, or making other jarring movements
• Vomiting
• Nausea
• Low-grade fever 
• Constipation
• Diarrhea
• Appetite loss
• Flatulence
• Abdominal bloating
• Painful urination
• Frequent urination

The exact cause of appendicitis is not known. It normally occurs when a portion of the appendix becomes blocked or obstructed. The possible causes of appendix obstruction are:

• Buildup of hardened stools
• Enlarged lymphoid follicles
• Intestinal worms
• Trauma or injury
• Tumors

The following factors may increase the risk of developing appendicitis:

• More common in men
• People in their twenties
• Family history of appendicitis

A general surgeon usually performs appendix surgery.

The following tests may be performed before an appendix surgery:

1. Physical examination: The doctor will apply gentle pressure on the painful area. The pressure is then suddenly released causing worsening of the appendicitis pain. The doctor also checks for abdominal rigidity and the tendency of the abdominal muscles to stiffen in response to pressure over the inflamed appendix. The symptoms, medical history, and family history of the patient are also noted.
2. Digital rectal exam: A gloved, lubricated finger is used by the doctor to examine the lower rectum (in which the stools are stored before being eliminated from the body).
3. Pelvic exam: It is performed by the doctor by the insertion of lubricated, gloved fingers into the woman’s vagina to check for gynecological problems that could be causing pain.
4. Blood test: A high white blood cell count could be indicative of an infection.
5. Urine test: Urinalysis helps in ruling out urinary tract infections or kidney stones that may be causing pain.
6. Imaging tests: Abdominal x-rays, CT scans, MRI scans, and ultrasounds help to obtain clear pictures of the appendix. 

The following preparation may be needed before an appendix surgery:

• The doctor should know about any medical illnesses that the patient may be suffering from.
• If the patient is currently taking any medications, supplements, or herbs, inform the doctor about the same.
• If the patient is sensitive or allergic to any medications, anesthetic agents, iodine, latex, or tape, tell the doctor about the same.
• Tell the doctor if the patient happens to be pregnant or is planning a pregnancy.
• The doctor may recommend stopping blood-thinning medications a few days before the procedure.
• Quit smoking at least two weeks before the procedure.
• The doctor will instruct the patient to not eat or drink anything after midnight, the day before the procedure.

The surgery is generally performed under general anesthesia, where the patient is made unconscious during the procedure. The procedure can be performed using any one of the following two techniques:

1. Open surgery:
The surgeon makes an incision (cut) which is approximately 2 to 4 inches long on the lower right side of the abdominal area.
The appendix is then spotted by the surgeon and removed.
In case of a ruptured appendix, the surgeon places a small tube, called a shunt, to drain out the pus and other fluids in the abdomen.
The shunt is taken out after some days, once the infection goes away.

2. Laparoscopic surgery:
This technique involves the surgeon making many small incisions or cuts in the abdominal area.
A laparoscope (a small tube consisting of a camera on one end) and some small surgical tools are inserted into the abdomen through the incisions made by the surgeon.
The procedure involves quick healing, lesser pain, and less scarring as compared to open surgery. 
This type of procedure is generally preferred in obese and aged adults.

The following are the post-procedure steps following an appendix surgery:

• The patient is normally discharged from the hospital a day or two after the surgery.
• The patient should avoid strenuous activities and heavy lifting for approximately three to five days following laparoscopic surgery, and for approximately ten to fourteen days following open surgery.
• The patient is told to apply pressure when he/she feels like laughing, coughing, or moving to reduce the pain.
• The doctor prescribes painkillers to relieve the pain and discomfort of the patient following the surgery.
• Antibiotics may be prescribed by the doctor to reduce the chances of infection.
• The patient is instructed to start moving around as soon as he/she can.
• The patient is instructed to drink lots of water and other fluids.
• The patient should keep the incision site dry and clean.
• The patient needs to take adequate rest following the surgery.
• The patient can usually resume his/her daily activities about one week after the surgery.

The following complications are associated with an appendix surgery:

• Infection
• Blood clot formation
• Bleeding
• Allergic reaction to the anesthesia used
• Abdominal bleeding
• Constipation
• Damage to the other abdominal organs
• Obstruction of the bowel
• Development of scar tissue on the intestine
• Opening of the incision made in the abdomen
• Infection in the incision area
• Intestinal leakage
• Abscess (pocket of pus) formation