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Surgery for Appendicitis

Usually an urgent condition, but readily treated

Appendicitis is an inflammation of the appendix, a small, closed, tube-like sac at the end of the first part of the colon (or large bowel).   This small appendage can become irritated and sometimes infected when its opening into the colon is blocked with mucus, stool, or a swelling of the lymph tissue. 

The severely inflamed appendix may rupture, with the potential of spreading infection through the abdomen.  Sometimes the body itself will contain the bacteria released by
this rupture and heal the appendix, and the pain and infection will resolve naturally.
  Other times, a ruptured appendix (or even a case of suspected appendicitis itself) can be treated successfully with antibiotics alone. 

However, the diagnosis of appendicitis is almost always treated as a medical emergency.  Patients usually undergo surgical treatment promptly because of the potential complications of a ruptured appendix.  Frequently, the site of perforation of the appendix becomes abscessed. Or, the bacteria released by the burst appendix will cause peritonitis, an infection of the lining of the abdomen and pelvis that can become very serious.  Less commonly, the inflammation can cause a disruption of colon function that results in a blockage of the bowel.  These complications are indications for immediate surgery targeted both at the ruptured appendix and any infectious process caused by it. 

Appendectomy

Appendectomy is the surgical procedure used to treat appendicitis, and it is the most common form of urgent gastrointestinal surgery.  In this operation, the surgeon removes the appendix and closes its connection to the colon.   The surgeon can perform an appendectomy either laparoscopically or through an open surgical procedure.  The laparoscopic approach also permits the team to fully confirm the diagnosis of appendicitis, through visualization of the appendix, without the patient incurring the large incision necessary for an open surgical appendectomy.

An appendectomy may also involve draining any abscesses that are present.  Furthermore, even in cases where symptoms of the ruptured appendix have been limited and have resolved on their own, surgeons often perform an appendectomy after several weeks to prevent a future attack of appendicitis.

An open appendectomy requires one incision that is two or three inches in length.  A laparoscopic appendectomy requires three much smaller puncture wounds.  Since less abdominal healing is required after a laparoscopy, this approach means less pain and faster recovery.

If the appendix has not yet ruptured by the time of its surgical removal, patients often need stay only one night in the hospital.  If the appendix has ruptured, patients will typically need to stay in the hospital for several days, as the medical team treats any abdominal infection (or risk of it) with antibiotics.

The appendix has no known function, and its removal does not appear to have any negative effects.  Full recovery from appendectomy requires several weeks, during which time patients need to limit physical activity.  Recovery may take longer if the appendix ruptured, or if there were complications such as abscess or peritonitis.