Appendicectomy
Laparoscopic / Open Appendicectomy
Appendicectomy is one of the most commonly performed emergency surgical procedure where the appendix is removed by an open or keyhole approach under general anaesthesia.
Indications:
1) Acute appendicitis: patient presents with acute right lower abdominal pain which may be associated with nausea, vomiting, diarrhoea or high temperature. If left untreated, the appendix can perforate and cause peritonitis and sepsis.
2) Interval appendicitis: where the initial acute attack was treated with antibiotics but appendicectomy is done as a planned procedure later on, to prevent further acute or grumbling symptoms
3) Small localised tumours of the appendix
Investigations:
1) Blood tests
2) Ultrasound scan in younger and pregnant patients
3) CT scan
4) MRI scan where ultrasound scan is inconclusive
Procedure
Appendicectomy performed under general anaesthesia. Open procedure is done with a transverse incision over the right lower abdomen. Keyhole procedure is done by three small incisions around the umbilicus and lower abdomen. The appendicular artery is cauterised and divided. The base of the appendix is ligated with sutures and divided above it. The appendix is then removed and sent for histological examination. All the infected fluid is washed out and a drain (plastic tube may be left for a few days to drain off any further collections. The skin wounds are closed with dissolvable stitches.
Complications: Wound infection or intra-abdominal collections (10%), bleeding, injury to other abdominal viscera.
Recovery
1) Keep the wounds dry for 4-5 day and do not soak the wounds in a bath or swimming pool for two weeks
2) Can start on light diet after surgery and gradually build to normal diet
3) Off work /school for two weeks
4) No contact sport or heavy exercises for four weeks
5) Avoid driving for two weeks and make sure you can press the pedals for an emergency stop without pain
6) Can go on short haul flights after two weeks, but please check with your travel insurance company and the airlines
Mr Midya performs about 100 appendicectomies every year, most of them as a trainer to teach surgical trainees. His complication rates are low with excellent patient satisfaction.
More information:
https://www.fhft.nhs.uk/patients-and-visitors/patient-information/appendicitis
https://www.nhs.uk/conditions/appendicitis/