Removal of the appendix is carried out under general anaesthetic using either keyhole or open surgery.
Keyhole surgery (laparoscopy) is usually the preferred method of removing the appendix because the recovery tends to be quicker than with open surgery.
The operation involves making 3 or 4 small cuts (incisions) in your tummy (abdomen).
Special instruments are inserted, including:
- a tube that gas is pumped through to inflate your abdomen – this allows the surgeon to see your appendix more clearly and gives them more room to work
- a laparoscope – a small tube with a light and a camera, which relays images of the inside of the abdomen to a television monitor
- small surgical tools used to remove the appendix
After your appendix has been removed, dissolvable stitches may be used to close the incisions.
If regular stitches are used, they'll need to be removed at your GP surgery 7 to 10 days later.
In some circumstances, keyhole surgery is not recommended and open surgery is used instead.
- when the appendix has already burst and formed a lump called an appendix mass
- when the surgeon is not experienced in laparoscopic removal
- people who have previously had open abdominal surgery
In open surgery, a single larger cut is made in the lower right-hand side of the abdomen to remove the appendix.
When there's widespread infection of the inner lining of the abdomen (peritonitis), it's sometimes necessary to operate through a cut along the middle of the abdomen. This procedure is called a laparotomy.
As with keyhole surgery, the incision is closed using either dissolvable stitches or regular stitches that need to be removed at a later date.
After both types of surgery, the removed appendix is sent to a laboratory to check for signs of cancer.
This is a precautionary measure and it's rare for a serious problem to be found.
One of the main advantages of keyhole surgery is the recovery time tends to be short and most people can leave hospital a few days after the operation.
If the procedure is carried out promptly, you may be able to go home within 24 hours.
With open or complicated surgery (for example, if you have peritonitis) it may take up to a week before you're well enough to go home.
For the first few days after the operation it's likely you'll have some pain and bruising. This improves over time, but you can take painkillers if necessary.
If you have had keyhole surgery, you may have pain in the tip of your shoulder for about a week.
This is caused by the gas that was pumped into your abdomen during the operation.
You may also have constipation for a short period after the operation.
To help reduce this, do not take codeine painkillers, eat plenty of fibre, and drink plenty of fluids.
Your GP can prescribe medication if the problem is particularly troublesome.
Before leaving hospital, you'll be advised about caring for your wound and what activities you should avoid.
You should be able to return to normal activities in a couple of weeks, although you may need to avoid more strenuous activities for 4 to 6 weeks after open surgery.
Your surgeon should discuss this with you.
When to get medical advice
While you recover, it's important to keep an eye out for signs of any problems.
Contact your care team at the hospital or your GP if you:
- have increased pain and swelling
- start vomiting repeatedly
- have a high temperature
- have discharge coming from the wound
- notice the wound is hot to touch
These symptoms could be a sign of infection.
Removal of the appendix is one of the most commonly performed operations in the UK, and serious or long-term complications are rare.
But like all types of surgery, there are some risks, including:
- wound infection – although antibiotics may be given before, during or after the operation to minimise the risk of serious infections
- bleeding under the skin that causes a firm swelling (haematoma) – this usually gets better on its own, but you should see your GP if you're concerned
- scarring – both types of surgery will leave some scarring where the incisions were made
- a collection of pus (abscess) – in rare cases, an infection caused by the appendix bursting can lead to an abscess after surgery
- hernia – at the site of the open incision or any of the incisions used in keyhole surgery
The use of general anaesthetic also carries some risks, such as the risk of an allergic reaction or inhaling stomach contents, leading to pneumonia.
But serious complications like this are very rare.
Alternatives to emergency surgery
In some cases, appendicitis can cause a lump called an appendix mass to form on the appendix.
The lump is made of appendix and fatty tissue, and is the body's way of trying to deal with the problem and heal itself.
If an appendix mass is found during an examination, your doctor may decide it's not necessary to operate immediately.
Instead, you'll be given a course of antibiotics and an appointment to have an operation a few weeks later, when the mass has settled.
There's not enough clear evidence to suggest that antibiotics could be used to treat appendicitis as an alternative to surgery.