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Appendectomy

definition

The operation to remove the inflamed appendix is colloquially referred to as appendectomy. In truth, however, this is not the appendix (Caecum), but around the appendix hanging on the appendix (Appendix vermiformis). In the following, the two terms are used as synonyms for the sake of simplicity. The appendix operation is also called medically Appendectomy (ectomy = cutting out). The most common reason for an appendectomy is an inflamed appendix (appendicitis), also called appendicitis. Often, however, the appendix is also removed during other abdominal operations in order to rule out later inflammation or complications.

Also read our topic: Appendicitis

Preparation for appendectomy

In Germany, the appendix operation is usually carried out with an inpatient stay. An appendix operation is usually carried out when there are acute symptoms, for example because of an inflammation. The patient is either referred by their family doctor or comes directly to the hospital via the emergency room. There, the person concerned is admitted as an inpatient. Diagnostic measures such as a physical exam, blood draw, and ultrasound are done first. If the suspicion is confirmed, the operation is planned. The patient must be sober for the operation. This means that you must not have eaten anything at least six hours before the procedure and have not drunk anything at least two hours beforehand. Furthermore, an assessment is carried out by an anesthetist who assesses the risk of anesthesia, recommends which medication should no longer be taken or which should still be taken and possibly carries out some tests (heart examination, lung tests, ...). A general or visceral surgeon will inform the patient and, if necessary, the parents (in the case of underage patients) about the operation, the procedure and possible complications of the procedure and then ask for their consent.

OP - sequence of an appendix operation

As soon as the appropriate operating capacity has been created and all preparations have been completed, the patient is brought into the operating room by the nursing staff, which is also referred to as "smuggling". There, the person concerned first gets to the anesthesia preparation room. There he is expected by an anesthetist and the anesthetist, who will take care of the induction of the anesthesia. The anesthetist asks for the patient-specific data again in order to summarize the most important things again and to avoid any mix-up. Here, if not already done, a venous access is usually placed in a vein on the back of the hand or arm. In addition, the patient is connected to the monitor, which measures blood pressure, heart rhythm and the oxygen content in the blood. After oxygen is given again via a mask, the doctor administers the anesthetic medication and the patient falls asleep. The anesthetist will push a ventilation tube into the windpipe and then drive the patient into the operating room.
The procedure of the appendix operation depends on whether an open or a laparoscopic (minimally invasive) operation is planned. Usually this will be a laparoscopic procedure. However, there are a few exceptions in which an open surgery may be necessary. In the open operation, an approximately 6 cm long incision is made in the right lower abdomen, over which the entire procedure takes place. In laparoscopic surgery, three surgical instruments (Throcars) made via three small, approx. 2 cm large incisions. One of these cuts is just below the belly button. A camera is introduced here. The robot-like throcars, which "lengthen" the surgeons' hands and through which the operation is carried out, are introduced over the other two incisions. In order to get an overview and to be able to work better, the stomach is inflated beforehand with gas (C02), which is released again after the end of the operation. The appendix in the right lower abdomen is found via one (open surgery) or three (laparoscopic) skin incisions. The appendix (appendix), which is also located, is attached to this. The surgeon will then clamp and sever the supplying vessels to cut off the blood supply. The appendix is removed and the stump closed with sutures. Finally, the abdominal wall is sewn up in layers and the skin is closed with staples or sutures. The patient is brought to the recovery room, where he has to remain in bed for about two hours before he can be brought back to a normal ward.

Follow-up treatment for an appendix operation

Treatment with antibiotics, usually metronidazole and ciprofloxazine, is often started during the operation and is continued for about five days. When the patient is back on his ward after the procedure, the follow-up treatment begins. The patient should stop eating on the day of the operation and slowly start a light diet the morning after. Postoperative symptoms caused by the anesthesia, such as nausea, cough, hoarseness, fatigue and sore muscles (rarely) are normal and should improve significantly during the first day. Pain at the surgical wounds is also completely normal and occurs especially when the pain medication of the anesthesia wears off. In this case, other pain relievers such as Novalgin® or ibuprofen can be given. The postoperative wound pain should improve significantly within a few days, although a much longer lasting pain can occur when the wounds are manipulated (coughing, laughing, sneezing, lifting heavy loads, ...). If a non-absorbable (dissolving) suture material was used during the operation (see discharge letter if applicable), a thread pull is necessary after about ten days, which can, however, be taken over by the family doctor. How long an inpatient stay is necessary varies depending on the course of the operation and the patient's condition. However, discharge is usually possible after about two to three days. The body should definitely be protected further.

Complications of appendix surgery

The appendix operation is one of the most frequently performed operations in Germany. The complication rate is very low (less than 0.1%), which is why the appendix is removed as a precaution, even in uncertain cases or in case of doubtful inflammation. The main complications include general anesthetic and surgical risks. These are wound infections, allergies, thromboses, embolisms, bleeding, injuries to vessels or nerves, pain, administration of blood transfusions with possible reactions to them, inflammation, intraoperative changes in the procedure, nausea, vomiting, injury to the teeth and hoarseness.
In addition to the general risk of surgery, appendectomy can lead to specific complications, such as damage to the intestine, neighboring organs, nerves or vessels, leaks at seams, inflammation, abscesses, wound infections, intestinal obstruction, adhesions and incisional hernias. In conclusion, every surgery is associated with a certain risk of complications. However, these are extremely rare in appendectomy, which is why they are one of the safest operations ever.

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Pain after appendectomy

An appendix operation is performed under general anesthesia. This means that the patient sleeps during the procedure and does not notice anything about the operation. Following the operation, postoperative wound pain may occur in the area of the cuts. These are initially very weak, as the anesthetic painkillers continue to work for a while. However, these become stronger as the disease progresses, usually reaching their maximum in the evening of the operation or at night. Overall, however, the postoperative wound pain during an appendectomy is tolerable. With laparoscopic procedures, they are slightly lower than with open ones, since the skin incisions are significantly smaller. As a rule, pain medication continues to be given after the operation in order to make the patient as pleasant as possible. These are mostly Novalgin® (metamizole) or ibuprofen. The pain should improve significantly over the next few days. Pressure pain in the relevant areas as well as pain when coughing, laughing, sneezing, defecating, moving and lifting heavy loads occur much longer over the course of the process and can also be noticeable after weeks. In the case of severe postoperative pain, pain medication with ibuprofen can be continued after discharge.

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Scar after an appendix operation

Where a scar occurs and how big it will be depends primarily on the type of surgery. In a minimally invasive operation, three small incisions are made that later become scars. Unfortunately, a scar cannot be avoided because the cuts are very deep. However, depending on the suturing process, the surgeon's technique and the subsequent protection, these can vary in thickness. The incision on the navel through which the camera is inserted is usually hidden within the navel and therefore very inconspicuous. The other two cuts can vary depending on the surgeon's technique and are therefore either on both sides of the bikini zone or in the middle and to the sides of the bikini zone. In the case of an open surgical procedure, an approximately 6 cm long, oblique incision is made in the right lower abdomen, which in the course of the process represents a more noticeable scar. Sufficient rest after the procedure can affect the size of the scar. By increasing tension, for example by moving a lot, it is stretched and thus wider. Over time, the scars usually shrink so much that after a few years they are hardly noticeable. In rare cases, pathological (abnormal) growths or incisional hernias (incisional hernia) can occur. In this case, it is recommended that you see a doctor again.

Duration of an appendix operation

The appendix operation is a very small and simple procedure, which is why the operation usually only takes about 20 minutes. A minimally invasive procedure usually takes a little longer than an open surgery. However, this is only mediocre and can vary greatly depending on the situation and patient. The duration of the operation also depends on whether the patient has already had an operation on the abdomen. When the abdominal wall is opened repeatedly, adhesions are usually found that make the operation much more difficult and cost time. If pathological (diseased) structures are found during the operation (e.g. a Meckel's diverticulum) or if complications arise, these are also corrected during the procedure, which can significantly increase the duration. If the appendicitis previously led to a rupture of the appendix, an open procedure will be used and at the same time a much more complex procedure with additional assessment of the peritoneum will be carried out. In addition to the actual operating time, however, the time for induction by the anesthesia and the subsequent stay in the recovery room must also be taken into account, which extends the overall duration of the procedure by a few hours.

When can you start doing sports again after an appendix operation?

From when a sporting activity is allowed again depends on the type of intervention and the respective sporting activity. A distinction is made between easy sports and heavy, stressful sports. Light sports include swimming, hiking, and careful cycling. Heavy sports include all ball and contact sports, strength training, weight lifting, and all types of competitive sports. With open surgical procedures, light sports can be performed from the 3rd week and heavy sports from the 6th week. With a minimally invasive appendix operation, earlier exposure is possible. Light sports can be undertaken from the 2nd week and heavy sports from the 4th week. The reason for this is the significantly shorter length of the scar. An incisional hernia is one of the most common complications in abdominal surgery, which is why it is very important to take adequate care. Physical exertion such as lifting heavy loads should therefore be completely avoided during the first two weeks.

What are the costs of an appendix operation?

The costs of an average appendectomy without major complications are between € 2,000 and € 3,000. The costs mainly depend on the length of stay in the hospital and the occurrence of complications. The occurrence of complications or peritonitis can double the total costs. A laparoscopic appendix operation is a few hundred euros more expensive than the classic, open method. The reason for this is the additional use of expensive surgical material (camera, throcars, ...). However, the costs are roughly offset by the fact that a minimally invasive operation is usually associated with a slightly reduced length of stay in the hospital.

How long are you sick after that?

The general practitioner usually decides how long a sick leave is necessary after an appendix operation. This depends on the current condition of the patient and their everyday life. Heavy work should not be restarted until two weeks after the operation to avoid complications such as incisional hernias. Light work, for example at the desk, school or study, can usually be started again after a week at the latest. It is important to always take care of yourself while working and, above all, to avoid lifting heavy loads or excessive pressure on the stomach. In any case, the wounds should be examined regularly in order to identify a possible change as early as possible.

How long is an appendix operation in the hospital?

The average length of hospital stay after an appendix operation is around two to three days. However, this relates to a typical course without complications in a healthy patient. In the case of severe disease, for example a ruptured appendix or peritonitis, the stay is extended by a few days, as longer observation and the administration of antibiotics are necessary. The duration can also change in the case of postoperative difficulties, such as inflammation or severe pain. In addition, patients are only discharged if they appear reasonably healthy and can stand up and walk well. Overall, the length of stay for laparoscopic procedures should be slightly shortened in contrast to the open technique.

Is an appendix operation also possible on an outpatient basis?

In principle, an outpatient appendix operation is possible, but very rarely. The reason for this is that such an operation is usually carried out due to acute appendicitis. Acute appendicitis should, however, be monitored following surgery to manage possible complications. An outpatient appendix operation is therefore only possible for elective (planned) operations. In the case of an outpatient operation, however, especially in the case of children, observation should be long enough to be on the safest possible side when discharging.