Treatment of Appendicitis
The Options, What To Expect and Complications
The treatment of appendicitis requires speed as well as making the right judgment call. Should antibiotics only be employed? Should you go for key hole surgery or open surgery? What should I expect? When can I go back to work? What about complications if any?
If nothing is done to treat an inflamed appendix within three days of unset of symptoms, the natural progression of the disease is that the condition worsens, pus may collect around the appendix forming an appendix abscess, an appendix mass may form, it may rupture, with potentially fatal sequelae.
How to treat appendicitis? Because appendicitis is a potentially life threatening condition, it is best treated in the hospital by qualified doctors with experience in this field. The definitive treatment of appendicitis is by surgically removing the diseased appendix in an operation known as appendicectomy or appendectomy.
It must be quickly mentioned here that where surgical option does not exist, like those on a submarine mission, or in a remote outpost, it is life saving to treat appendicitis with antibiotics. Doing so though, only buys time. The appendicitis may re-occur again.
It must be stressed that is not the best option. A broad spectrum antibiotic is usually advised. This may include a choice of metronidazole, at a dose of 500mg three times daily with cefuroxime or augumentin 1.2grams 8hrly given through the veins.
The gold standard for the treatment of appendicitis is by an operation to take off the offending appendix.
This involves putting the patient to sleep under general anaesthetics to prevent pain during the operation. The operation can be done either as a key hole surgery (laparoscopic) or the traditional open knife surgery.
Treatment of Appendicitis: Keyhole or Open Surgery?
The decision whether to do a key hole appendectomy or open appendectomy depends on a number of factors, including the surgeon's experience with this procedure (keyhole surgery), the fitness of the patient for endoscopic appendicectomy and the level of complication expected or even occurring during a previously planned endoscopic (laparoscopic) surgery. Most surgeons will not perform a laparoscopic appendicectomy (appendectomy) if:
- The patient is severely obese
- Patient is too frail for prolonged anaesthesia
- There is fear of the appendix already ruptured and may need extensive internal abdominal toileting
- The expertise and or facility for endoscopic appendicectomy does not exist.
Please discuss with your surgeon and agree on a choice of how to treat appendicitis in you or your loved one where possible.Some have asked: what's the difference between a key hole removal of the appendix and an open one? Well, in terms of getting the job done, both methods achieve exactly the same result - the appendix is removed, curing the appendicitis. The main difference lies in:
- The open surgery tends to be a faster procedure(usually about 20 to 30 minutes operating time), meaning less time under general anaesthetics, and on the operating table, especially important if patient has some other illness, frail or difficulty with breathing or chest problems. The key hole surgery or laparoscopic removal of the appendix tend to take longer (about 60 to 90 minutes), though operating time is getting shorter these days, with more and more surgeons operating this way
- Key hole appendicitis operation leaves smaller (0.5 to 1.5cm scar - but up to four) scars on the abdomen , as against the traditional open surgery that leaves a 5 to 10 cm scar on the right lower abdomen
- More importantly, there tends to be less pain and quicker recovery after a key hole surgery
Please be warned: If complications occurs during a keyhole appendicectomy, the surgeon may have to convert the surgery to an open operation to save life. Many of such complications are often unpredictable as well as out of the operating surgeons control. They could include unexpected rupture of the appendix, uncontrollable blood loss (bleeding), or the finding of a large necrotic tumour with or without a diseased appendix. More reasons to leave how to treat appendicitis - the details of it to your surgeon!
Preparation Before The Surgery
Surgery for the treatment of appendicitis is usually done as an emergency operation. Even at that, adequate preparation will help reduce complication rates after surgery, and aid smooth recovery. The following preparation is expected in most cases:
- The procedure to be undertaken is explained to the patient
- Should have nothing to eat or drink for at least 4 to 6 hours before the operating time - to prevent patient vomiting stomach content into the lungs when put to sleep under general anaesthesia. This could have fatal consequences
- An intravenous line will be inserted to take some bloods for testing, if not already done, to see your blood count level, if you have enough "salts" (electrolytes) in your blood, and how well your blood clotting system is.
- You are most likely going to get some intravenous fluids given to help restore lost fluids to our body and optimize your circulation.
- In the treatment of appendicitis, it is also important that you get good pain killers preferably intravenously, as well as some antibiotics given top you intravenously before the operation.
You will then be transferred to theater for the operation. Remember, you will not feel pain during the operation, and it is usually a very straight forward procedure with very very high success rate.
After putting the patient to sleep, he or she is transferred unto the operating table. The abdomen is thoroughly cleaned with special antiseptic solutions, special coverings placed over the abdomen. Dignity is ensured at every moment, seeing that patient is properly covered even while asleep, and only the region to be operated on is exposed.
If it is a key hole surgery,
- A cut is made around the belly button (umbilicus), and a small tube introduced into the abdomen to put in some carbon-dioxide gas to help expand the space in the abdomen to provide room for the operation inside
- 2 to 3 other cuts are made to introduce the instruments that will be used to remove the appendix, including the telescope (camera) for viewing the field been operated upon.
- The appendix is identified and tied with a ligature, cut off and delivered through a cut on the wall of the abdomen - usually the 1 to 1.5cm cut by the belly button (umbilicus).
- The wound on the abdominal wall is sutured and closed.
- Plaster applied to the closed wound, and the operation is finished.
For an open procedure, step 1 and 2 is skipped, and instead, a direct cut is made on the abdomen, the appendix see under direct vision, tied off and removed.
After Surgery for Treatment of Appendicitis
Patient is then transferred over to the recovery room, where he or she gradually "recovers" from the anaesthesia, wakes up only to find out that the operation is long finished. You may have nurses or doctors checking your blood pressure, see that you have adequate pain control, and that you are not bleeding from the operation site.
After a an hour or so, patient is transferred to a proper post operative ward, observed for a day or two.
- You should be able to start sips of clear fluids from the end of the first day, light food by day two, and
- Discharged home at the end of day 2 or day 3.
- You may need some additional antibiotics (often not required!) to go home, depending on if the surgery is deemed "clean" or not in terms of any faecal contamination during the operation.
- Simple pain killers like paracetamol or codeine with ibuprofen may be given to control pain
- You will need to keep the site of the wound clean and free from water for about 7 days, when the stitches will need to be removed, if a type of stitch that is not absorbed is used to close the skin.
Other Frequently Asked Questions After Appendicectomy
Common questions asked after treatment of appendicitis include:
- When can I start to have my bath after surgery? Answer: As soon as you feel okay to do so, without causing excessive pain and strain to the operated site, and more importantly, not letting water to touch the healing wound within the first 7 to 10 days. Once the stitches have been removed and the wound looks dry and healed, you can start having your bath fully.
- When can I resume sex after surgery? Answer: Again, when you feel comfortable to, but ideally, not before the first 2 weeks after surgery, so as not to put too much strain on your abdominal wound.
- When can I go back to work after an appendicectomy operation? Answer: After an open surgery, you need about 4 weeks to recover on the average, especially if your work involves lifting, or prolonged standing, or shouting. This is more so after an open appendicectomy operation. For a key hole surgery, 2 weeks is often enough rest time.
- When can I start driving after an a surgical operation to remove the appendix? Answer: Drive when you feel comfortable to. Be sure you are able to do the emergency stop manoeuvrings without any pain. Always cross check with your car insurance provider.
Treatment of Appendicitis : The Complications of Surgery
Generally, this operation is straight forward, and the vast majority of people do not have any significant complication after surgery. But it is worth noting that every surgery carries some risk as well as complications.
Following the treatment of appendicitis by surgery, expect to
Obviously have a scar,
- You may bleed, and there is a
- Risk of the wound getting infected.
- If a nerve that runs in the area of the operation called the ilio-inguinal nerve is inadvertently damaged, the patient could come up with hernia in the future.
- The risk of general anaesthesia is also there.
- For those who will have key-hole surgery, the gas pumped into the abdominal cavity may cause irritation of your diaphragm and possibly pain at the tip of the shoulder for some days after the surgery
- There is also a tiny risk of some individuals developing chronic abdominal pain after many months or years following the operation from what is called adhesions caused after surgery - especially open surgery.