What are the other Names for the Procedure?
- Surgical Removal of the Vermiform Appendix
What is Open Appendectomy surgical procedure?
- Open Appendectomy involves making a 2-4 inch deep incision on the right side of the lower abdomen. The appendix is separated from the surrounding abdominal organs, cut and then removed
- The stump (small part of the appendix that remains after the cut) is either inverted or cauterized. The abdominal wall is then closed and the skin sutured
- In case the appendix has already ruptured; further management varies depending upon the severity of infection and inflammation, whether there is an abscess (pus formation) or a phlegmon (inflammatory mass)
- In that situation, the surgeon decides upon the treatment based on various other factors
What part of the Body does the Procedure involve?
An Open Appendectomy procedure involves the following parts of the lower abdomen:
- Cecum (part of the large intestine)
- Peritoneum (wall surrounding the abdominal cavity)
Why is the Open Appendectomy surgical procedure Performed?
- An Open Appendectomy surgery is performed in case there is an infection/inflammation of the appendix, called an appendicitis
- The person suffers from severe pain (initially around the umbilicus and then radiating to the lower aspect of the right side abdomen) accompanied by a host of other symptoms
- These could include nausea, vomiting, loss of appetite, fever, and chills
What are some Alternative Choices for the Procedure?
- The appendix could be removed, either through an open surgery or a keyhole laparoscopic procedure
- In this approach, the surgeon makes 3 or 4 small incisions for the camera and laparoscopic instruments. The appendix is then cut and removed
- If the patient is suffering from severe appendicitis, surgery is the only option as there is a danger that the appendix may rupture, causing abscess in the neighboring tissue. This may also lead to other complications
What are the Recent Advances in the Procedure?
- The recent development in Appendectomy is the use of laparoscopic techniques, where scarring is minimal and recovery much faster
- This technique involves making smaller incision which permits surgical equipment and a video camera to pass through into the abdomen
- However, it is not suitable for all cases of Appendectomy; especially when the appendix is ruptured
What is the Cost of performing the Open Appendectomy surgical procedure?
The cost of Open Appendectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding Appendectomy and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
What are some Helpful Resources?
Prior to Open Appendectomy surgical procedure:
How is the Open Appendectomy surgical procedure Performed?
The surgery is performed under general anesthesia.
Where is the Procedure Performed?
The procedure is performed at a hospital or out-patient surgery center facility.
Who Performs the Procedure?
The procedure is usually performed by a general surgeon.
How long will the Procedure take?
- The time taken for an Open Appendectomy surgical procedure is usually about 90 minutes. However, this time may vary depending on the following:
- The kind of Appendectomy performed
- After the incision is made, if the appendix is found to have ruptured; it will take additional time, as the abscess has to be cleaned
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
A physician will request your consent for the Open Appendectomy procedure using an Informed Consent form.
What is the Consent Process before the Procedure?
A physician will request your consent for the Open Appendectomy procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Open Appendectomy surgical procedure?
Based on the condition of the patient and their symptoms, the physician may ask for any or all of the following:
- Complete blood count test
- Basic metabolic panel
- X-ray of abdomen
- Ultrasound or CT Scan of abdomen
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is an Open Appendectomy?
- What choices do I have apart from an Appendectomy?
- What are the available surgical options? Which one of them is cost effective and which one ensures faster recovery?
- Do I really need a surgery? How long can I wait before undergoing the surgery?
- What are the risks while performing the procedure?
- How long will it take for me to completely recover from the surgical procedure?
- How long will it take to recover? When can I resume normal work?
- What will happen if the appendix ruptures eventually?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- Is there any medication that needs to be taken for life, after the procedure?
- What are the costs involved?
During the Open Appendectomy surgical procedure:
What kind of Anesthesia is given, during the Procedure?
In this procedure, a general anesthesia or a spinal anesthesia is administered.
How much Blood will you lose, during the Procedure?
The amount of blood loss during a laparoscopic procedure is minimal. However, in an Open Appendectomy the amount of blood loss, though controlled depends on the type of complications that might arise during the procedure.
What are the possible Risks and Complications during Open Appendectomy surgical procedure?
There are general factors that increase the risk of complications during the procedure, which include:
- Obesity: Generally greater the degree of obesity, greater is the surgical risk
- Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders, chronic infections
- Poor immune system due to a variety of causes
- Taking some prescription or non-prescription medication: It is very important to inform your healthcare provider the complete list of all such medications. This will help assess the surgical risk for complications
The possible risks or complications that may arise during the surgery are:
- Injury to the neighboring structures
- Anesthetic complications
- Need for further procedures
What Post-Operative Care is needed at the Healthcare Facility after Open Appendectomy surgical procedure?
- At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise
- After surgery, the patient is observed for a short duration of time, if the patient underwent a simple Appendectomy
- If there are complications, the patient is admitted and has to be monitored to see if they are recovering well
After the Open Appendectomy surgical procedure:
What are the possible Risks and Complications after Open Appendectomy surgical procedure?
- Abscess formation in the abdominal cavity
- In case of pregnant women, there is a 5% chance of losing the fetus
- Blood clot formation
- Heart problems
What is the Prognosis after the Surgery?
- After the surgery, it may take about 3 weeks for a complete recovery
- Simple Appendectomy has an excellent prognosis
- However, if there are complications and the appendix has ruptured the prognosis is still good. But, there could be a longer recovery period
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Swelling around the surgical wound.
- Bleeding or discharge
- Nausea or vomiting
- Side effects to any medication, which is prescribed by the physician
- Headache or dizziness
What Post-Operative Care is needed at Home after Open Appendectomy surgical procedure?
At home, the following post-operative care is recommended, after an Open Appendectomy procedure:
- Immediately for a few weeks after the surgery, have a diet consisting only of liquids or semi-solids
- Take complete rest for 2-3 weeks and avoid any strenuous physical activities, before slowly getting back to your regular daily routine
- Complete the prescribed course of medications
- Avoid pain killers, unless prescribed
- Avoid all possibilities of constipation; take medication if required to do so
How long does it normally take to fully recover, from the Procedure?
It takes about 2-3 weeks to fully recover from an Open Appendectomy surgery.
What happens to tissue (if any), taken out during the Procedure?
The surgically removed appendix is taken for further medical examination and later disposed, as per standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Open Appendectomy surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility or a hospital
- A general surgeon
- An anesthesiologist (if anesthesia was administered)
- A pathologist (if the tissue was sent for analysis)
The patient is advised to inquire and confirm the type of billing, before an Open Appendectomy procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA