Appendicectomy

What it is

Removal of the inflamed appendix, the blind-ended tube hanging off the caecum at the start of the large intestine. Usually done through three small keyhole incisions with a camera (laparoscopically), occasionally through a single cut in the right lower abdomen.

Why it is done

• Acute appendicitis, to prevent perforation and peritonitis
• An appendix mass or abscess after initial antibiotics and drainage
• Occasionally, an appendix tumour found on imaging or during other surgery

Before the procedure

• Blood tests, pregnancy test in women, sometimes ultrasound or CT
• Nil by mouth; intravenous fluids and antibiotics
• Consent and marking; general anaesthetic

Step by step

1. Carbon dioxide inflates the abdomen through a port at the navel to create working space
2. A camera and two instruments are introduced through 5-12 mm ports
3. The appendix is lifted, its blood supply in the mesoappendix sealed, and its base tied or stapled at the caecum
4. The appendix is removed in a bag; any pus is washed out
5. Ports are removed and the small wounds closed with dissolvable stitches

Afterwards

• Home the same or next day for uncomplicated cases
• Simple painkillers; walk early
• Antibiotics continued for a few days if the appendix had perforated

Recovery

Back to desk work in about a week and to sport in two to four weeks after keyhole surgery; longer after open surgery or a perforated appendix.