Operation

– Acute appendicitis

– Tumors of the appendix

Technique

In the vast majority of cases, surgery is performed with keyhole surgery. First, a space is created in the abdominal cavity by injecting CO2 gas.

The operation is usually performed through three holes. One port for the camera and two others to insert instruments (forceps, grapplers, scissors, etc.) needed for the dissection of the appendix.

After loosening the attachments of the appendix, ligatures are inserted at the base of the appendix and one distally to prevent pus and faeces from flowing into the abdominal cavity.

The appendix is cut off between the ligatures. The appendix is then removed from the abdominal cavity through the umbilicus. Pus ,when present, is aspirated from the abdominal cavity.

If the abdominal cavity is contaminated (pus, faecal material…) after perforation of the appendix, the surgeon may decide to leave a drain. Depending on the degree of contamination with pus or faeces treatment with antibiotic may be extended for several days.

Wound infection:

• Redness and swelling of the wound. Intermittent suppurating fluid from the scar.

Abscess in the abdominal cavity:

• Pain in the abdomen, fever, nausea, vomiting.

Incisional hernia:

• +/- 0,7 %
• Swelling under the scar.
• In case of strangulation of the bowel: abdominal bloating with nausea and vomiting.

Long-term complications of appendectomy: a systematic review T Rasmussen Scand J Surg. 2018 September;107(3): 189-196

Cochrane Library 2018 Laparoscopic versus open surgery for suspected appendicitis

Normal symptoms

In normal conditions, pain is well controlled with paracetamol (Dafalgan®), NSAIDs (anti-inflammatories) or morphine (Tradonal®…) and pain symptoms diminish over time.

• Abdominal bloating gradually decreases postoperatively for 2 weeks.
• Shoulder pain  (24-48 hours) due to irritation from the CO 2-gas injected during the laparoscopic procedure.
• Urinary retention may occur in the first hours after the procedure. Temporary placement of a urinary catheter may be necessary.
• Nausea and vomiting  (24-48 hours) may occur. Adolescents and especially young women are more affected.
• Hardening and pain at the level of the scar. The wound may feel hard for several weeks.
• Pain is often aggravated by sudden movements of the abdominal wall laughing, coughing, sneezing,….).
• On returning home, the joy of returning home, is often followed by an increase in fatigue and sometimes a drop in morale.

Abnormal symptoms

If certain symptoms seem abnormal to you contact your doctor.

• Postoperative abdominal pain that does not subside but increases with time.
• Persistent fever.
• Inability to eat due to nausea and vomiting.
• Increased bloating.

If this is not possible, you can contact avec your surgeon.

If you are unable to contact your GP or your surgeon, go to the emergency department at St Elizabeth Hospital in Uccle.

• Appendicectomy has no effect on fertility.
• Appendicectomy has no effect on digestion.

A low risk of ileus, incisional hernia and impact on female fertility after appendectomy. Ugeskr. Laeger 2018 Nov 26;180(48):V04180291