Laparoscopic appendectomy: appendicitis signs, surgery and recovery

The pain usually starts around the belly button and, within a few hours, moves to the lower right side of the tummy, where it becomes worse. It may hurt more when you move, cough or press on it (NHS). Other signs include:

• feeling or being sick, and loss of appetite
• a high temperature
• constipation or diarrhoea, or needing to pee more often
• sudden confusion in older people

Go to an emergency department immediately for severe tummy pain, or for confusion, blotchy or pale skin, or difficulty breathing, which can be signs of sepsis (NHS). If the appendix bursts, the pain may ease briefly and then become severe and spread across the abdomen. Symptoms are often less typical in pregnancy, young children and older people, so do not rule appendicitis out yourself.

The appendix is a small pouch attached to the large bowel. Appendicitis happens when it becomes infected and swollen, often because something such as undigested food or hard stool blocks it (NHS). It is common, most often in children over 10 and young adults.

Removing it is the usual treatment, and because the body does not need the appendix, taking it out does no harm (NHS). The main danger is delay: a burst appendix can cause peritonitis, sepsis, an abscess or a bowel blockage, all of which need urgent surgery and antibiotics.

Other conditions, including urinary infections, kidney stones, gallstones, a ruptured ovarian cyst and ectopic pregnancy, can cause similar pain (NHS). The doctor examines your tummy and may arrange blood and urine tests, an ultrasound or CT scan, and a pregnancy test where relevant. No single test always confirms appendicitis, so you may be observed in hospital for a few hours.

When appendicitis is very likely or the appendix may have burst, surgery may go ahead without further tests. Antibiotics alone may be used if the infection has not spread and surgery is high risk for you, and an appendix mass is usually treated with antibiotics first, with surgery weeks later if symptoms continue (NHS).

Surgery is done as soon as possible, though you may wait a few hours. Under general anaesthetic, the operation takes about an hour (NHS):

1. Small cuts are made in the tummy and a thin camera is passed inside.
2. The appendix is removed where it joins the bowel.
3. If it has burst, the area is cleaned.
4. The cuts are closed with stitches, clips or glue.

Keyhole surgery is typically used, but an open operation with a larger cut is sometimes needed (NHS), for example when the appendix has burst and the infection has spread or the view is not safe.

Because this is usually urgent, preparation happens in the emergency department. Take your medicines with you, or a list of them (NHS), and do not drive yourself to hospital.

Tell the team about blood thinners, allergies, diabetes and any chance of pregnancy, and avoid eating or drinking once surgery is being considered unless you are told otherwise. The anaesthetist checks your health before the operation, and you are asked to sign a consent form that includes the possibility of converting to open surgery.

After the operation you rest in the recovery room, move to a ward and are given pain relief. After keyhole surgery you may go home the next day; open surgery or complications can mean a few days in hospital. You can leave once you are eating, drinking and able to open your bowels (NHS).

Most people recover in 1 to 2 weeks and need 1 to 2 weeks off work or school, longer for a physical job or after a burst appendix. Finish any antibiotics, eat more fibre and drink fluids if you are constipated, avoid strenuous sport until fully recovered, and drive only when you can do an emergency stop safely (NHS).

Complications after appendix surgery are rare. They include a wound infection, bleeding, an abscess, adhesions that rarely block the bowel, and stump appendicitis, when the small part of the appendix left behind becomes inflamed (NHS).

In the large CODA trial, complications within 90 days occurred in 3.5 per 100 people who had an appendectomy, and serious adverse events in 3.0 per 100 (CODA, NEJM). The general risks of keyhole surgery, such as injury to an organ or blood vessel and blood clots, are rare (NHS).

Contact the surgical team or seek urgent medical advice the same day if you notice (NHS):

• soreness or redness around a wound that is getting worse
• bleeding or pus from a wound
• a high temperature

Go to the nearest emergency department for severe tummy pain, confusion, blotchy or pale skin, or difficulty breathing (NHS).

Removing the appendix cures appendicitis, and you do not need the appendix to stay healthy (NHS). Most people are back to their usual activities within 1 to 2 weeks, while complications such as a burst appendix make recovery longer.

A follow-up visit may be offered but is not always needed (NHS). Keep the wound care instructions you were given, and let the team know about any new pain or fever in the weeks after surgery.

Antibiotics have been studied as an alternative to surgery. In the US CODA trial of 1,552 adults, antibiotics were comparable to appendectomy for health status at 30 days, but nearly 3 in 10 people in the antibiotic group had their appendix removed within 90 days (CODA, NEJM).

People with an appendicolith, a hard stone in the appendix, had more complications with antibiotics alone (CODA, NEJM). The choice is made with the surgeon once the diagnosis is confirmed.

Appendix surgery is usually an emergency admission, so the cost depends on the hospital and its emergency department, the scans and blood tests, keyhole or open surgery, the anaesthetic, antibiotics and the number of nights in hospital. A burst appendix with an abscess usually means a longer stay and more treatment.

If you have been told you need a planned operation, for example after an appendix mass treated with antibiotics, ask for a written quote that lists the surgeon, anaesthesia, hospital stay and follow-up. Dr. Yasser also performs laparoscopic gallbladder removal and hernia repair. For a non-urgent question or a planned operation you can book a consultation with Dr. Yasser; for sudden pain, go to an emergency department first.