Appendectomy (Appendix Surgery) in Delhi, India

Appendectomy is a surgical procedure performed to remove the appendix, a small tube-like organ at the lower end of the ascending colon (located in the lower right side of the abdomen). The procedure becomes necessary when the appendix becomes inflamed due to factors such as blockage caused by stool or bacteria. An inflamed appendix can rupture or burst, causing a medical emergency.

There are two ways of performing an appendectomy:

Open Appendectomy

An open appendectomy involves making a 2-4 inch long incision in the abdomen to access the appendix. It is then cut and taken out through the incision. It is the preferred option in case the appendix has ruptured, as it allows the surgeon to thoroughly clean the abdominal cavity.

Laparoscopic (Keyhole) Appendectomy

During a laparoscopic appendectomy, 1-2 small incisions are made. A laparoscope equipped with a video camera and surgical tools is inserted via one of the incisions. The camera helps guide the surgeon in viewing inside the abdomen. The appendix is cut and removed via the laparoscope, and the incisions are sutured. Laparoscopic appendectomy is increasingly preferred due to its minimally invasive nature, leading to faster recovery and reduced postoperative discomfort.

An appendectomy is generally done within 24 hours of diagnosis.

• Pre-surgery evaluation: Before undergoing surgery, blood tests and imaging scans are performed to confirm the nature and severity of the appendicitis. Apart from the tests, the doctor will also review the medical history including any current medications, allergies, or pre-existing medical conditions. All these evaluations help doctors decide which type of surgery is most suitable. In some cases, additional imaging, such as an MRI, may be recommended to gain better insight into the condition, especially in pregnant patients or those with atypical symptoms.
• Pre-surgery Instructions: Typically, patients are instructed to fast for a certain amount of time prior to the surgery and are prescribed antibiotics to be taken before the procedure. Patients may also be advised to avoid certain medications, such as blood thinners, to minimise bleeding risks during the operation.

The appendectomy procedure starts by administering general anaesthesia to ensure comfort during the surgery. Following the administration of anaesthesia, the specific surgical steps vary as per the type of the appendectomy:

Laparoscopic Appendectomy Steps

• The surgeon starts by making 2-3 small incisions near the navel. A tiny port is inserted through one of the incisions.
• This is then followed by placing a small tube (cannula) through the port via which the abdomen is inflated with carbon dioxide gas. After inflation, the cannula is then removed. 
• The surgeon then inserts the laparoscope, which is used to locate the appendix near the colon. The appendix is tied off, detached from the colon, and removed from the body. Finally, the incisions are sutured.

Open Appendectomy Steps

• During an open appendectomy, the surgeon makes a large incision in the lower right abdomen. 
• Once the surgeon locates the appendix, the infection is drained from the abdominal cavity, and the area is rinsed with a sterile saline solution. 
• The appendix is tied, cut off from the colon and removed from the body. After the appendix is removed, the abdominal tissue is repositioned and the incision is closed with sutures. 

In addition to relieving the inflammation associated with appendicitis, laparoscopic appendectomy offers several advantages, including:

• Less scarring
• Shorter recovery time
• Reduced risk of infection
• Shorter hospital stay

These benefits make laparoscopic appendectomy a preferred choice for many patients, particularly those with no complications.

As with any surgery, appendectomy is associated with certain risks. These include:

• Infection: Infection at the incision site is a potential risk after any surgery. 
• Bleeding: Bleeding during or after surgery at the incision site is another common risk.
• Damage to surrounding organs: Although rare, there is a possibility of damage to surrounding organs, including the bladder and the intestines.
• Anaesthesia risks: As with any surgery performed under anaesthesia, there are risks, including allergic reactions and/or breathing issues

1. What tests are performed for appendicitis diagnosis?

Doctors use a combination of tests to confirm appendicitis, including:

• Physical Exam: Checking for tenderness in the lower right abdomen.
• Imaging Tests: Ultrasounds or CT scans to identify inflammation or a rupture.
• Blood Tests: Used to detect signs of infection or elevated white blood cell counts.
• Urine Tests: To rule out urinary tract infections or kidney stones that might mimic appendicitis symptoms.

2. Can appendicitis be treated without appendectomy?

Antibiotics are not a long-term solution for appendicitis. Surgery is typically necessary to prevent a rupture, which can cause severe complications such as peritonitis or sepsis. For chronic or recurrent appendicitis, surgical removal remains the definitive treatment.

3. What signs suggest that the appendix has ruptured?

A ruptured appendix is a medical emergency, and common signs include:

• Intense and worsening abdominal pain.
• High fever and chills.
• Rapid heart rate and breathing difficulties.
• Nausea, vomiting, and abdominal bloating.
• Confusion or disorientation, which can occur due to sepsis.

Immediate medical attention is critical in such cases.

4. Does living without an appendix cause any long term health issues?

No significant long-term health issues are associated with living without an appendix. The organ’s role in the body is considered minimal, and its removal does not affect the digestive or immune systems. Patients can live normal, healthy lives after an appendectomy.

5. What foods to eat and avoid after an appendectomy?

Recommended foods:

• Light, easy-to-digest meals such as soups, boiled vegetables, and porridge.
• Low-fibre options like white rice, applesauce, or mashed potatoes during early recovery.

Foods to avoid:

• High-fibre foods like raw fruits, whole grains, and legumes, which can strain digestion.
• Spicy or fatty foods that may irritate the stomach.
• Caffeinated or carbonated beverages should also be avoided initially.

6. Does smoking or drinking affect recovery after an appendectomy?

Yes, both smoking and alcohol can slow down recovery. Smoking reduces oxygen flow to healing tissues, slowing wound repair, while alcohol weakens the immune system, increasing infection risks. Quitting smoking and avoiding alcohol during recovery are strongly recommended.

Reviewed by Dr Arun NC Peters, Senior Director - Bariatric Surgery / Metabolic, Minimal Access & Laparoscopic Surgery, Department of General Surgery and Robotics on 9 Dec 2024.