m The appendix is a small, finger-shaped organ

extending from the first part of the large

intestine. It is removed when it becomes
inflamed or infected. A perforated appendix
can leak and infect the entire abdominal area,
which can be life-threatening.
m An appendectomy is done under general
anesthesia, which means you are asleep and do
not feel any pain during the surgery. The
surgeon makes a small cut in the lower right side
of your belly area and removes the appendix.
m The appendix can also be removed using
minimally invasive techniques. This is called a
laparoscopic appendectomy. It is performed
with small incisions and a camera.
m If the appendix ruptured or a pocket of
infection (abscess) formed, your abdomen will
be thoroughly washed out during surgery. A
small tube may be left in the belly area to help
drain out fluids or pus.
2
 The appendix is a closed-ended, narrow, worm-like tube
up to several inches in length that attaches to the cecum (the first
part of the colon). (The anatomical name for the appendix,
vermiform appendix, means worm-like appendage.) The wall of the
appendix contains lymphatic tissue that is part of the immune system
that makes antibodies.
˜
 



2

The appendix sits at the junction of the small intestine and large
intestine. It's a thin tube about four inches long. Normally, the
appendix sits in the lower right abdomen.
m The function of the appendix is unknown. One
theory is that the appendix acts as a storehouse
for good bacteria, ´rebootingµ the digestive
system after diarrheal illnesses. Other experts
believe the appendix is just a useless remnant
from our evolutionary past. Surgical removal of
the appendix causes no observable health
problems.
m 2
  Inflammation of the appendix,
the small worm-like projection from the first part
of the colon. Appendicitis usually involves
infection of the appendix by bacteria that
invade it and infect the wall of the appendix.
Appendicitis can progress to produce an
abscess (a pocket of pus) and even peritonitis
(inflammation of the lining of the abdomen and
pelvis).
m The most common signs and symptoms of
appendicitis are fever, and abdominal
tenderness, and right lower quadrant
abdominal pain most marked at what is called
McBurney's point. Appendicitis is suspected on
the basis of the patient's history and physical
examination. A white blood cell count, urinalysis,
abdominal x-ray, barium enema,
ultrasonography, CT scan, and laparoscopy also
may be helpful in diagnosis.
m Because of the varying size and location
of the appendix and the proximity of
other organs to the appendix, it may be
difficult to differentiate appendicitis from
other abdominal and pelvic diseases. The
treatment for appendicitis is antibiotics
and appendectomy (surgery to remove
the appendix). Complications of
appendectomy may include wound
infection and abscess.
m The most exquisitely tender area of the
abdomen in the early stage of appendicitis, this
point is named after the New York surgeon
Charles McBurney (1845-1913), the leading
authority in his day on appendicitis. In 1889,
McBurney showed that incipient appendicitis
could be detected by applying pressure to a
particular spot in the right lower abdomen, a
point he called the "seat of greatest pain,"
which corresponds to the normal location of the
base of the appendix.
m An appendectomy is surgery to remove
the appendix.
m An w


 (sometimes called
w


 or w


) is the
surgical removal of the vermiform appendix.
This procedure is normally performed as an






, when the patient is
suffering from acute appendicitis.
m In the absence of surgical facilities, intravenous
antibiotics are used to delay or avoid the onset
of sepsis; it is now recognized that many cases
will resolve when treated non-operatively. In
some cases the appendicitis resolves
completely; more often, an inflammatory mass
forms around the appendix. This is a relative
contraindication to surgery.
m The symptoms of appendicitis vary. The condition can be
hard to diagnose, especially in children, the elderly, and
women of childbearing age.
m Most often, the first symptom is pain around your belly
button.
m The pain may be vague at first, but it becomes sharp and severe.
m The pain often moves into your right lower abdomen and
becomes more focused in this area.
m Other symptoms include:
m Fever (usually not very high)
m Reduced appetite
m Nausea and vomiting
m If you have symptoms of appendicitis, seek immediate
medical help. Do not use heating pads, enemas,
laxatives, or other home treatments to try and relieve
symptoms.
m Your health care provider will examine your abdomen
and rectum. Other tests may be done.
m Blood tests, including a white blood cell count (WBC), may be
done to check for infection.
m When the diagnosis is not clear, the doctor may order a CT
scan or ultrasound to make sure the appendix is the cause of
the problem.
m There are no actual tests to confirm that you have
appendicitis. Other illnesses can cause the same or
similar symptoms.
m The goal is to remove an infected appendix before it
breaks open (ruptures). After reviewing your symptoms
and the results of the physical exam and medical tests,
your surgeon will decide whether you need an
operation.
m Even when the surgeon discovers the appendix is not
infected, it will be removed to prevent future
problems.
m Risks for any anesthesia include the following:
m Reactions to medications
m Problems breathing
m Risks for any surgery include the following:
m Bleeding
m Infection
m Other risks with an appendectomy after a ruptured
appendix include the following:
m Longer hospital stays
m Side effects from medications
m Surgeons use one of two surgical techniques,
open appendectomy or laparoscopic
appendectomy. The choice of method is made
by the surgeon on a case-by-case basis.
General anesthesia (agent that renders the
patient unconscious) is used in both procedures.
m Open appendectomy is the traditional method
and the standard treatment for appendicitis.
The surgeon makes an incision in the lower right
abdomen, pulls the appendix through the
incision, ties it off at its base, and removes it.
Care is taken to avoid spilling purulent material
(pus) from the appendix while it is being
removed. The incision is then sutured.
m If the appendix has perforated (ruptured), the
surgeon cleans the pus out of the abdomen with
a warm saline solution to reduce the risk for
infection. A drain may be inserted through the
incision to allow the pus to drain from the
abdomen. In this case, the skin is not sutured, but
left open and packed with sterile gauze. The
gauze and drain remain in place until the pus is
completely drained and there is no sign of
infection.
m If the abdomen is so inflamed that the surgeon
cannot see the appendix, the infection is
drained and treated with antibiotics, and then
the appendix is removed.
m Laparoscopic appendectomy has been used for
several years and has become the standard of
care. The procedure has several advantages
including lower risk for postoperative infection,
faster recovery time, a smaller scar, and a
shorter hospital stay.
m The surgeon makes a very small incision right
below the navel and inserts an instrument called
a laparoscope. The laparoscope is a long tube
with a lens at one end and a miniature video
camera at the other. The laparoscope enables
the doctor to see the appendix. Several more
tiny incisions are made to allow for the passage
of instruments, which are used to cut and clamp
off the appendix.
m The laparoscope is also used as a diagnostic
tool. The doctor is able to see if the appendix is
inflamed and, if the appendix is not the cause
of the patient's symptoms, other organs can be
seen in order to identify the source of the
symptoms.
m A number of tests are ordered to assess the patient's
health before surgery. Usually these tests are done a
few days ahead, but because of the urgency of an
appendectomy, the tests and surgery are frequently
performed on the same day. Preoperative tests vary
according to the patient's age and health, but a blood
test, chest x-ray, and electrocardiogram (EKG) are
standard.
m An 

 

 
 must be signed
acknowledging that the patient understands the
procedure, the potential risks, and that they will
receive certain medications.
m Before surgery, the anesthesiologist visits
the patient to do a brief physical
examination and to obtain a medical
history. He or she will want to know about
any other medical conditions; if the patient
is taking any medication (prescription or
over-the-counter);
m if any dietary supplements or herbal
products are being used; if there has been
recent illicit drug use; if the patient smokes
cigarettes or drinks alcohol; if the patient
has a history of allergies, especially to
medications; or has had a previous
reaction to anesthesia, or a family history
of problems with anesthesia.
m Patients are required to refrain from
eating or drinking after midnight on the
day before surgery; however, because an
appendectomy is an emergency
procedure, that may not be possible. As
soon as the decision is made to operate,
the patient must take nothing by mouth,
including oral medications.
m Prior to surgery, an intravenous (IV) is
started to administer fluid and medications
that have been ordered, including
antibiotics and pain medication. A
sedative may be given to help the patient
relax. Anesthesia is administered in the
operating room.
In general terms, the procedure for an open
appendectomy is as follows:
1. Antibiotics are given immediately if there are signs
of sepsis, otherwise a single dose of prophylactic
intravenous antibiotics is given immediately prior to
surgery.
2. General anaesthesia is induced, with endotracheal
intubation and full muscle relaxation, and the patient
is positioned supine.
3. The abdomen is prepared and draped and is
examined under anesthesia.
4. If a mass is present, the incision is made over
the mass; otherwise, the incision is made over
McBurney's point, one third of the way from
the anterior superior iliac spine (ASIS) and the
umbilicus; this represents the position of the
base of the appendix (the position of the tip is
variable).
5. The various layers of the abdominal wall are
then opened.
[. The effort is always to preserve the integrity
of abdominal wall. Therefore, the External
Oblique Aponeurosis is slitted along its fiber,
and the internal oblique muscle is split along
its length, not cut. As the two run at right
angles to each other, this prevents later
Incisional hernia.
7. On entering the peritoneum, the appendix is
identified, mobilized and then ligated and
divided at its base.
8. Some surgeons choose to bury the stump of the
appendix by inverting it so it points into the caecum.
9. Each layer of the abdominal wall is then closed in
turn.
10.The skin may be closed with staples or stitches.
11.The wound is dressed.
12.The patient will be brought to the recovery room.
m Following surgery, the patient is taken to the
postanesthesia care unit (PACU) until the
anesthesia wears off. During this time, the
nursing staff checks temperature, heart rate,
and breathing at frequent intervals. When the
anesthesia wears off and vital signs stabilize,
the patient is transferred to their hospital room.
m With an unruptured appendix, the patient's
recovery time is relatively quick. The morning
after surgery, clear liquids are offered. Once
those are tolerated, the diet progresses to solid
food. Once the patient is eating and drinking,
the intravenous is removed.
m Physical activity, such as getting out of bed,
begins on the same day as surgery or the next
morning. Most patients need medication to
relieve the pain in and around the incision. The
smaller incisions of a laparscopic procedure
often cause less pain than the large incision
made in open appendectomy.
m The nursing staff continues to monitor the
patient for signs of infection and checks that the
incision is healing. Patients with uncomplicated
surgeries usually leave the hospital 1 or 2 days
following surgery.
m =
w

, the patient must check the
incision site. It should be dry and the wound
should be completely closed. If the incision
drains blood or pus, or if the edges are pulling
apart, the physician should be notified
immediately. Fever and increasing pain at the
incision site also should be reported to the
physician.
m Normal activities can be resumed within a few
days, but it takes 4 to [ weeks for full recovery.
Heavy lifting and strenuous activity should be
avoided during recovery. If antibiotics and/or
pain medication are prescribed, they should be
taken as directed.
m The open procedure leaves a scar on the lower
right side of the abdomen that is a few inches
long and fades over time. Scarring from
laparoscopic appendectomy is minimal.
m Recovery from surgery for a perforated
appendix is longer, primarily because the
infection must be treated. The hospital stay is at
least 4 days and can be longer, if complications
develop. The drain remains in place until the pus
stops draining, and the nursing staff changes
the gauze packing as needed. Intravenous
antibiotics continue throughout the
hospitalization.
m When discharged, oral antibiotics are
prescribed and should be taken as directed.
The drain and gauze pack remain in place, and
instructions are given on proper care of the
area. It is important to inform the physician if
the amount of drainage suddenly increases, or
if the color and consistency changes. The drain
is removed on an outpatient basis after the
infection has resolved.
m @w w  
 may occur following the
operation. The bowel is normally in constant
motion, digesting food and absorbing nutrients.
Disturbing the bowel, even by the surgeon's just
touching it, can cause the motion to come to a
standstill. Fluid and gas may then cause the
bowel to swell or distend. A nasogastric tube is
passed through the nose and into the stomach to
relieve the distension.
m When bowel function returns to normal (evident
by passing gas or having a bowel movement),
the tube is removed. Until that time, food and
liquid are not permitted by mouth, and
hydration is maintained intravenously. Paralytic
ileus is more common when the appendix has
perforated.
m º


 can cause the skin to become
red and inflamed and pus to leak from the
incision site. In this case, antibiotics are started
and discharge from the hospital may be
delayed, depending on the severity of the
infection. On rare occasions, the site must be
reopened to allow the wound to drain.
m Patients tend to recover quickly after a simple
appendectomy. Most patients leave the hospital in 1 -
3 days after surgery. You can resume normal activities
within 2 - 4 weeks after leaving the hospital.
m Recovery is slower and more complicated if the
appendix has ruptured or an abscess has formed.
m Living without an appendix causes no known health
problems.