Appendicectomy

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Indications Benefits Techniques Preparation Procedure Recovery Risks FAQ

An appendicectomy is a surgical procedure to remove the appendix, a small, finger-shaped organ attached to the large intestine.

It is most commonly performed as an emergency surgery when the appendix becomes inflamed, a condition known as appendicitis. Without timely removal, the appendix can rupture, leading to severe infection within the abdomen.

Indications for an Appendicectomy

An appendicectomy is performed when a patient has symptoms or conditions requiring appendix removal, such as:

Acute Appendicitis

Sudden inflammation causing sharp abdominal pain, usually starting near the navel before moving to the lower right abdomen. Other symptoms may include nausea, vomiting, and fever.

Chronic Appendicitis

Recurrent mild inflammation leading to persistent or intermittent lower right abdominal discomfort. Symptoms are often less severe but can cause ongoing digestive issues.

Appendiceal Tumour

A growth or mass detected in the appendix during imaging or surgery. Some are benign, while others require removal to prevent complications, including cancer.

Prophylactic Removal

In some cases, the appendix is removed during unrelated abdominal surgery to lower the risk of future complications, especially if abnormalities are present or there is a higher risk of appendicitis.

Benefits of an Appendicectomy

An appendicectomy helps prevent complications and improves recovery outcomes.

Prevention of Severe Infection

Removing an inflamed appendix before rupture lowers the risk of peritonitis, a serious infection of the abdominal cavity that can lead to further complications.
Pain Relief

Surgery eliminates persistent discomfort and reduces the likelihood of future episodes in cases of chronic appendicitis.
No Effect on Digestion

The appendix is not involved in digestion, and its removal does not impact digestive function or overall health.
Short Recovery Period

Most patients experience a smooth recovery, with a brief hospital stay and a return to daily activities within a few weeks.

Surgical Techniques

Laparoscopic Appendicectomy

This technique involves making 3–4 small incisions in the abdomen to insert a tiny camera and surgical instruments. The appendix is removed using specialised tools, and the incisions are closed with stitches or surgical glue. Performed under general anaesthesia, the procedure typically takes 45–60 minutes. Recovery is generally quicker, with minimal scarring.

Open Appendicectomy

This approach requires a single incision (5–10 cm) in the lower right abdomen to remove the appendix. It is often used if the appendix has ruptured, if there is a severe infection, or when laparoscopy is not suitable. The procedure takes approximately 30–45 minutes, with a longer hospital stay if an infection is present.

Preparing for Surgery

Medical Assessment

A physical examination, blood tests, and imaging (ultrasound or CT scan) confirm the diagnosis and help plan the procedure. These tests assess the severity of the condition and determine the patient’s readiness for surgery.

Medication Review

Certain medications, such as blood thinners, may need to be paused to reduce the risk of bleeding. Antibiotics are usually given before the procedure to lower the chance of infection and support recovery.

Fasting Requirements

No food or drink should be consumed for at least 6–8 hours before surgery to reduce the risk of anaesthesia-related complications, such as aspiration, and support a stable procedure.

Step-by-Step Procedure

Anaesthesia Administration

General anaesthesia is administered to ensure the patient remains unconscious and free of pain throughout the procedure. Vital signs, including heart rate, blood pressure, and oxygen levels, are closely monitored during surgery.

Surgical Site Preparation

The abdomen is cleaned with an antiseptic solution to reduce the risk of infection. The surgeon then marks the incision sites based on whether a laparoscopic or open approach is being used.

Accessing the Appendix

In the laparoscopic method, small incisions are made, and the abdomen is inflated with carbon dioxide to create space and improve visibility. A tiny camera is inserted to guide the surgeon. In the open method, a single incision is made in the lower right abdomen, and the appendix is carefully located by gently separating surrounding tissues.

Appendix Removal

The blood supply to the appendix is sealed using sutures or surgical clips to prevent bleeding. The appendix is then carefully detached and removed through the incision, with additional steps taken if rupture or infection is present.

Closure of the Surgical Site

The incisions are closed with dissolvable stitches, staples, or surgical glue, depending on the approach used. A sterile dressing is applied to protect the area and support healing.

Post-Surgical Care and Recovery

Monitoring and Pain Management

After surgery, vital signs are closely monitored to ensure a smooth recovery. Pain relief is provided through medication, and any discomfort is usually mild to moderate, improving over the next few days. Some patients may experience temporary nausea or drowsiness as the effects of anaesthesia wear off.

Activity and Wound Care

Light movement, such as walking, is encouraged soon after surgery to promote circulation and reduce the risk of complications. Patients should avoid heavy lifting, intense exercise, or straining for several weeks. The incision site should be kept clean and dry, with dressings changed as instructed to support healing.

Follow-Up and Recovery Timeline

Most patients can resume daily activities within a few weeks, depending on the surgical approach and individual recovery speed. A follow-up appointment is scheduled to assess healing, remove stitches if needed, and check for any signs of infection or complications.

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Potential Risks and Complications

An appendicectomy is a commonly performed procedure, but potential risks include infection, which may cause redness, swelling, or discharge at the incision site. Bleeding is uncommon but can occur during or after surgery. Some patients may have temporary digestive sluggishness caused by scar tissue affecting bowel movement. In certain cases, a weakness in the abdominal wall at the incision site may lead to a hernia. There is also a small risk of abscess formation, particularly if the appendix was perforated before surgery.

Dr Calvin Ong Jianming

Senior Consultant, Colorectal & General Surgeon

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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