Treatment - Appendicitis

If you have appendicitis, your appendix usually needs removal as soon as possible. This operation is known as an appendectomy or appendicectomy.

Removing the appendix is usually recommended if appendicitis is suspected, rather than risk it bursting.

In humans, the appendix doesn't perform any important function. Having it removed doesn't cause any long-term problems.

The procedure

The surgeon will carry out an appendectomy under general anaesthetic. This will be either keyhole or open surgery. The medical name for keyhole surgery is laparoscopy.

Keyhole surgery (laparoscopy)

Keyhole surgery is usually the preferred method of removing the appendix. The recovery tends to be quicker than with open surgery. 

This operation involves making 3 or 4 small cuts (incisions) in your tummy.

Special instruments are then inserted, including:

• a tube that pumps gas through to inflate your abdomen. This allows the surgeon to see your appendix clearly and gives them more room to work
• a laparoscope. This is a small tube containing a light source and a camera. It relays images of the inside of your tummy to a television screen.
• small surgical tools used to remove the appendix

After your appendix has been removed, dissolvable stitches may be used to close the incisions.

Open surgery

Sometimes, keyhole surgery isn't recommended and you might have open surgery instead.

These include:

• when the appendix has already burst and formed a lump called an appendix mass
• when the surgeon is less experienced in laparoscopic removal
• when you have had open abdominal surgery before

In these cases the surgeon will make a single larger cut to remove the appendix. This will be in the lower right-hand side of your tummy.

After surgery, the hospital sends the appendix to a laboratory to check there are no signs of cancer. This is a precautionary measure, and it's rare to find a serious problem.

Recovering from surgery

One of the main advantages of keyhole surgery is the recovery time tends to be short. Most people can leave hospital a few days after the operation. If the appendix is operated upon promptly, most patients can go home within 24 hours of the operation. With open or complicated surgery it may take up to a week before you're well enough to go home.

For the first few days after the operation you're likely to have some pain and bruising. This improves over time, and you can take painkillers if you need to.

If you had keyhole surgery, you may have pain in the tip of your shoulder for about a week. The pumping of the gas into your tummy during the operation causes this pain.

You may also have constipation for a short period after the operation. To help reduce this, do not take codeine painkillers, take paracetamol or ibuprofen and eat plenty of fibre, and drink plenty of fluids. Your GP can prescribe medication if it does not improve.

Before leaving hospital, a member of staff will tell you how to look after your wound. They will will also tell you what activities you should avoid.

In most cases, you can return to normal activities in a couple of weeks. You may need to avoid strenuous activities for 4 to 6 weeks after open surgery.

When to seek medical advice

While you recover, it's important to look out for signs of any problems.

Risks of surgery

Appendectomies are one of the most commonly-performed operations in Ireland. Serious or long-term complications are rare.

But, like all types of surgery, there are some risks. These include:

• wound infection. You might get antibiotics to minimise the risk of serious infections
• bleeding under the skin that causes a firm swelling (haematoma). This usually gets better on its own, but you should see your GP if you're concerned
• scarring – both surgical techniques will leave some scarring where the incisions were made
• a collection of pus (abscess) - in rare cases, an infection caused by the appendix bursting can lead to an abscess after surgery
• hernia – at the site of the open incision or any of the incisions used in the laparoscopic approach

The use of general anaesthetic also carries some risks. These include the risk of an allergic reaction. You could also inhale stomach contents. This could lead to pneumonia. But serious complications like this are very rare.

Read about complications from appendicitis

Informed consent

This information on the risks of surgery is only a guide. It is not a substitute for the proper consent process you will have with your doctor.

The consent process will happen before your surgery. Your doctor will meet with you to explain your surgery and the possible risks of complications. You should ask them any questions you have before giving your consent to go ahead with the surgery.

You should only give your consent when you feel you have all the information you need to make an informed decision.

Alternatives to emergency surgery

In some cases, appendicitis can lead to the development of a lump on the appendix called an appendix mass.

This lump is an attempt by the body to deal with the problem and heal itself. It contains appendix and fatty tissue.

Your doctor may find an appendix mass during an examination. If they do, they may decide there is no need to operate immediately

Instead, they'll give you a course of antibiotics. You will get an appointment for an appendectomy a few weeks later, when the mass has settled.