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Appendectomy is the surgical removal of the appendix. The appendix is a worm-shaped hollow pouch attached to the cecum, the beginning of the large intestine.


Appendectomies are performed to treat appendicitis, an inflamed and infected appendix.


Since appendicitis occurs most commonly in males between the ages of 10-14 and in females between the ages of 15-19, appendectomy is most often performed during this time. The diagnosis of appendicitis is most difficult in the very young (less than two years of age) and in the elderly.


Appendectomy is considered a major surgical operation. Therefore, a general surgeon must perform this operation in the operating room of a hospital. An anesthesiologist is also present during the operation to administer an anesthetic. Most often the anesthesiologist uses a general anesthetic technique whereby patients are put to sleep and made pain free by administering drugs in the vein or by agents inhaled through a tube placed in the windpipe. Occasionally a spinal anesthetic may be used.
After the patient is anesthetized, the general surgeon can remove the appendix either by using the traditional open procedure (in which a 2-3 in [5-7.6 cm] incision is made in the abdomen) or via laparoscopy (in which four 1 in [2.5cm] incisions are made in the abdomen).

Traditional open appendectomy

When the surgeon uses the open approach, he makes an incision in the lower right section of the abdomen. Most incisions are less than 3 in (7.6 cm) in length. The surgeon then identifies all of the organs in the abdomen and examines them for other disease or abnormalities. The appendix is located and brought up into the wounds. The surgeon separates the appendix from all the surrounding tissue and its attachment to the cecum and then removes it. The site where the appendix was previously attached, the cecum, is closed and returned to the abdomen. The muscle layers and then the skin are sewn together.

Laproscopic appendectomy

When the surgeon conducts a laproscopic appendectomy, four incisions, each about 1 in (2.5 cm) in length, are made. One incision is near the umbilicus, or navel, and one is between the umbilicus and the pubis. Two other incisions are smaller and are in the right
A traditional open appendectomy. After the surgeon makes an incision in the lower right section of the abdomen, he/she pulls the appendix up, separates it from the surrounding tissue and its attachment to the cecum, and then removes it.
A traditional open appendectomy. After the surgeon makes an incision in the lower right section of the abdomen, he/she pulls the appendix up, separates it from the surrounding tissue and its attachment to the cecum, and then removes it.
(Illustration by Electronic Illustrators Group.)
side of the lower abdomen. The surgeon then passes a camera and special instruments through these incisions. With the aid of this equipment, the surgeon visually examines the abdominal organs and identifies the appendix. Similarly, the appendix is freed from all of its attachments and removed. The place where the appendix was formerly attached, the cecum, is stitched. The appendix is removed through one of the incisions. The instruments are removed and then all of the incisions are closed.
Studies and opinions about the relative advantages and disadvantages of each method are divided. A skilled surgeon can perform either one of these procedures in less than one hour. However, laproscopic appendectomy (LA) always takes longer than traditional appendectomy (TA). The increased time required to do a LA increases the patient's exposure to anesthetics, which increases the risk of complications. The increased time requirement also escalates fees charged by the hospital for operating room time and by the anesthesiologist. Since LA also requires specialized equipment, the fees for its use also increases the hospital charges. Patients with either operation have similar pain medication needs, begin eating diets at comparable times, and stay in the hospital equivalent amounts of time. LA is of special benefit in women in whom the diagnosis is difficult and gynecological disease (such as endometriosis, pelvic inflammatory disease, ruptured ovarian follicles, ruptured ovarian cysts, and tubal pregnancies) may be the source of pain and not appendicitis. If LA is done in these patients, the pelvic organs can be more thoroughly examined and a definitive diagnosis made prior to removal of the appendix. Most surgeons select either TA or LA based on the individual needs and circumstances of the patient.
Insurance plans do cover the costs of appendectomy. Fees are charged independently by the hospital and the physicians. Hospital charges include fees for operating and recovery room use, diagnostic and laboratory testing, as well as the normal hospital room charges. Surgical fees vary from region to region and range between $250-$750. The anesthesiologist's fee depends upon the health of the patient and the length of the operation.


Once the diagnosis of appendicitis is made and the decision has been made to perform an appendectomy, the patient undergoes the standard preparation for an operation. This usually takes only one to two hours and includes signing the operative consents, patient identification procedures, evaluation by the anesthesiologist, and moving the patient to the operating suites of the hospital. Occasionally, if the patient has been ill for a prolonged period of time or has had protracted vomiting, a delay of few to several hours may be necessary to give the patient fluids and antibiotics.


Recovery from an appendectomy is similar to other operations. Patients are allowed to eat when the stomach and intestines begin to function again. Usually the first meal is a clear liquid diet-broth, juice, soda pop, and gelatin. If patients tolerate this meal, the next meal usually is a regular diet. Patients are asked to walk and resume their normal physical activities as soon as possible. If TA was done, work and physical education classes may be restricted for a full three weeks after the operation. If a LA was done, most patients are able to return to work and strenuous activity within one to three weeks after the operation.


Certain risks are present when any operation requires a general anesthetic and the abdominal cavity is opened. Pneumonia and collapse of the small airways (atelectasis) often occurs. Patients who smoke are at a greater risk for developing these complications. Thrombophlebitis, or inflammation of the veins, is rare but can occur if the patient requires prolonged bed rest. Bleeding can occur but rarely is a blood transfusion required. Adhesions (abnormal connections to abdominal organs by thin fibrous tissue) is a known complication of any abdominal procedure such as appendectomy. These adhesions can lead to intestinal obstruction which prevents the normal flow of intestinal contents. Hernia is a complication of any incision, However, they are rarely seen after appendectomy because the abdominal wall is very strong in the area of the standard appendectomy incision.
The overall complication rate of appendectomy depends upon the status of the appendix at the time it is removed. If the appendix has not ruptured the complication rate is only about 3%. However, if the appendix has ruptured the complication rate rises to almost 59%. Wound infections do occur and are more common if the appendicitis was severe, far advanced, or ruptured. An abscess may form in the abdomen as a complication of appendicitis.

Key terms

Abscess — A collection of pus buried deep in the tissues or in a body cavity.
Anesthesiologist — A physician who has special training and expertise in the delivery of anesthetics.
Anesthetics — Drugs or methodologies used to make a body area free of sensation or pain.
Cecum — The beginning of the large intestine and the place where the appendix attaches to the intestinal tract.
General surgeon — A physician who has special training and expertise in performing a variety of operations.
Pelvic organs — The organs inside of the body that are located within the confines of the pelvis. This includes the bladder and rectum in both sexes and the uterus, ovaries, and fallopian tubes in females.
Pubis — The anterior portion of the pelvis located in the anterior abdomen.
Thrombophlebitis — Inflammation of the veins, usually in the legs, which causes swelling and tenderness in the affected area.
Umbilicus — The navel.
Occasionally, an appendix will rupture prior to its removal, spilling its contents into the abdominal cavity. Peritonitis or a generalized infection in the abdomen will occur. Treatment of peritonitis as a result of a ruptured appendix includes removal of what remains of the appendix, insertion of drains (rubber tubes that promote the flow of infection inside the abdomen to outside of the body), and antibiotics. Fistula formation (an abnormal connection between the cecum and the skin) rarely occurs. It is only seen if the appendix has a broad attachment to the cecum and the appendicitis is far advanced causing destruction of the cecum itself.

Normal results

Most patients feel better immediately after an operation for appendicitis. Many patients are discharged from the hospital within 24 hours after the appendectomy. Others may require a longer stay—three to five days. Almost all patients are back to their normal activities within three weeks.
The mortality rate of appendicitis has dramatically decreased over time. Currently, the mortality rate is estimated at one to two per 1,000,000 cases of appendicitis. Death is usually due to peritonitis, intra abdominal abscess or severe infection following rupture.
The complications associated with undiagnosed, misdiagnosised, or delayed diagnosis of appendectomy are very significant. The diagnosis is of appendicitis is difficult and never certain. This has led surgeons to perform an appendectomy any time that they feel appendicitis is the diagnosis. Most surgeons feel that in approximately 20% of their patients, a normal appendix will be removed. Rates much lower than this would seem to indicate that the diagnosis of appendicitis was being frequently missed.



McCall, J. L., K. Sharples, and F. Jafallah. "Systematic Review of Randomized Controlled Trial Comparing Laproscopic with Open Appendectomy." British Journal of Surgery 84, no. 8 (August 1997): 1045-1950.


"Appendectomy." ThriveOnline.
"The Appendix." Mayo Clinic Online.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


excision of the vermiform appendix.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


Surgical removal of the appendix.
Synonym(s): appendicectomy
[appendix + G. ektomē, excision]
Farlex Partner Medical Dictionary © Farlex 2012


n. pl. appendecto·mies
Surgical removal of the vermiform appendix.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


The surgical removal of the appendix.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.


Surgery The removal of an appendix by a conventional–McBurney abdominal–incision or by laparoscopy Anesthesia General Hospital stay 1-3 days, shorter if laparoscopic. See Appendicitis.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


Surgical removal of the vermiform appendix.
Synonym(s): appendicectomy.
[appendix + G. ektomē, excision]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012
References in periodicals archive ?
It was also found to be significantly associated with more negative appendicectomies than OA (p = 0.002).
Negative appendicectomies constituted 17% of the total operations, and the appendixes were found to be diseased with some other pathology in 4% of the operations.
(1) Primary Mucinous Adenocarcinoma of the Appendix is very rare accounting for 0.05% to 0.2% of all appendicectomies and only 6% of all malignant tumour of the appendix.
Percentages for positive and negative appendicectomies in males were 77 and 23, while in females 45 and 55 respectively.
The 30 patients who had appendicectomies comprised 14 males and 16 females, with a mean age of 27 years for males (range 7 - 49) and 23 years for females (8 - 42).
The goal of surgical treatment is removal of an inflamed appendix before perforation with a minimal number of negative appendicectomies. Many studies have shown that appendicitis is associated with elevated C-reactive protein.
We carried out a descriptive study of 242 appendicectomies carried out at our institution during the 5 years starting from January 2004.
So many appendicectomies are performed for non-appendiceal pathologies, so-called unnecessary or negative appendectomies because of similarities in the clinical presentation, especially in young women.
Appendicectomies were performed under general anesthesia using the standard technique.
We undertook a retrospective study of appendicectomies, believing it to be an excellent means of evaluating the surgical service as a whole in this region.
(5) Multiple scoring systems have been developed in order to identify those patients who need emergency appendicectomy thus avoiding the risk of delay as well as identifying patients unlikely to need surgery, thus decreasing the burden of negative appendicectomies. Of these, Alvarado score system described by Alfredo Alvarado in 1986 was most widely studied.
For a surgeon confronting a patient with suspected acute appendicitis, the decision to operate or not is not always straightforward, because one has to keep in mind the complications associated with negative appendicectomies and at the same time to prevent missed appendicitis leading to complications.