Laparoscopic appendicectomy is a ‘keyhole’ operation where the appendix is removed. By far the most common reason for an appendicectomy is acute appendicitis. This is a common surgical emergency whereby the appendix becomes inflamed and infected and in some cases can perforate (burst) and lead to peritonitis, a very severe infection.. The procedure is done under a general anaesthetic (fully asleep). A 1-2cm incision is made through the umbilicus (belly button) and a port placed. Carbon dioxide gas is insufflated into the abdominal cavity. A laparoscope (telescope) is inserted through a port. The diagnosis is confirmed. Two further 5mm incisions are made. One is placed just above the pubic bone and one in the lower left side of the abdomen. If there is infected fluid, this is removed by suction. The abdominal cavity is washed out if there is contamination. The appendix is removed after its blood supply is controlled. The wounds are closed with dissolvable sutures.
Most people spend one night in hospital and can be discharged in the morning following the surgery. If the appendix is gangrenous or perforated, then a few days on intravenous antibiotics is needed.
Most people recover well and reasonably quickly and feel almost back to normal within 1 – 2 weeks. Usually, people require 1 week off work but this can be longer if one has a physical job.
Pain is usually well controlled with simple pain killers. You should take regular analgesia in the first 48 hours including paracetamol (Panadol) 1g (2 tabs) every 4-6 hours (max 8 tabs per day) and an anti-inflammatory such as ibuprofen (nurofen) 400mg every 4 – 6 hours. You may be given a prescription for a stronger pain killer such as oxycodone (endone) or tramal (tramadol) to use in addition as well. After 48 hours, use the painkillers only if needed. Antibiotics may also be prescribed for a week but this is usually only necessary if the appendix was gangrenous or perforated.
The wounds will be closed with dissolvable stitches that are underneath the skin and therefore don’t need removing. The stitches can take months to fully dissolve. A dressing will be placed over the wound. Leave this on for 1 week. You can wash or shower with these water-proof dressings.
There are no dietary restrictions after an appendicectomy.
Don’t do any strenuous activities for 2 weeks. Don’t lift anything over 1-2kg during this time. Walking and normal activities around the house is encouraged if you feel comfortable enough. From 2 -4 weeks you can jog or swim if there is no discomfort. Don’t do any abdominal exercises for at least 4 weeks and then start slowly and continue if you don’t feel any discomfort.
Most people recover without any problems. The most important complications include
Infection – this can be either in the wounds or deeper in the abdomen. If the wounds become red, inflamed or start discharging pus, you may have a wound infection. See your GP or contact the rooms to make an appointment to see your surgeon. Intra-abdominal infections can occur (especially for severe appendicitis) and usually manifest as high fevers, abdominal, pelvic pain and/or vomiting. Contact your surgeon if you are concerned.
Bleeding – this is very uncommon
Conversion to open surgery – in severe cases, a larger open incision may be needed to complete the operation. This increases the length of time for recovery.
Deep Vein Thrombosis (DVT)
Extremely rare complications include
Damage to other organs, air embolism (from the carbon dioxide)