Pediatric Surgery

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Appendectomy

Appendectomy is the surgical removal of the appendix when an infection has made it inflamed and swollen. This infection, called appendicitis, is considered an emergency because it can be life threatening if untreated — occasionally, an inflamed appendix bursts after a day of symptoms. So it's very important to have it removed as soon as possible.

Fortunately, appendectomy is a common procedure and complications are rare. And if appendicitis is promptly diagnosed and an appendectomy is performed, most kids recover quickly and with little difficulty.

About Appendicitis

Located in the abdomen, the appendix is a small organ that isn't important to a person's health. One end of the appendix is closed and the other opens into the large intestine, the organ that absorbs water from waste (or stool) and moves it out of the body through the anus.

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Causes

There's no way to prevent appendicitis. Because the appendix is so close to the large intestine, it can become clogged with stool and bacteria. Other times mucus produced by the appendix can thicken and cause a blockage. In both cases, once the opening to the appendix is congested, it can become inflamed and swollen, causing appendicitis.

Signs and Symptoms

Appendicitis can cause sudden pain in the middle of the abdomen, usually concentrated around the bellybutton. The pain often moves to the lower right part of the abdomen. At first, pain might come and go, then become persistent and sharp.

Appendicitis also can cause:

  • loss of appetite
  • fever
  • nausea
  • vomiting
  • diarrhea
  • frequent or painful urination

If the appendix bursts, a child can develop a high fever, and pain will move throughout the abdominal area.

The Surgery

A child who needs an appendectomy will be admitted to the hospital. The surgeon will describe the procedure and answer your questions. Ask the surgeon to explain anything about the procedure that you don't understand.

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An anesthesiologist or a certified registered nurse anesthetist (CRNA) will come in to talk to you about the type of anesthesia to be used.

The surgical team will determine and discuss with you which of these two common surgical types of appendectomy is appropriate for your child:

  1. Open Appendectomy
    An open appendectomy is the "traditional" way of removing an infected appendix. Basically, a surgeon makes an incision in the abdomen and locates the infected appendix. The appendix is cut away from the large intestine and removed from the body. The incision is then closed with stitches.

  2. Laparoscopic Appendectomy
    Laparoscopy is a type of surgery that uses a tiny video camera called a laparoscope to help surgeons see inside the body. The thin tube of the laparoscope is inserted into the body through a small incision and guided to the appendix to act as the surgeon's "eyes." Other small incisions are made so medical instruments can be guided to the area, and the entire operation is done while the surgeon looks at a TV monitor.

Sometimes appendectomy is done using a combination of procedure types. In rare cases, a surgeon might start with the laparoscopic procedure but change to an open procedure during surgery. This can happen because the surgeon has trouble finding the appendix with the laparoscope or previous surgeries might have left the patient with abdominal scar tissue that makes it difficult to remove the appendix through laparoscopy.

If this happens, the surgeon will either close up the small incisions and immediately begin the open appendectomy or end the surgery and reschedule the appendectomy.

After Surgery

After the surgery, your child will be taken to a recovery room, which is sometimes called the "post-op" (post-operative) room or PACU (post-anesthesia care unit).

It usually takes about an hour for a child to completely wake up from the anesthesia. People react to anesthesia in a variety of ways, and while most feel fine afterwards, it's possible your child may feel groggy, confused, chilly, nauseated, scared, alarmed, or even sad when waking up.

Also, your child might feel some pain near the incision site, but medication can help lessen it so be sure to let doctors or nurses know if your child is uncomfortable or in pain.

Caring for Your Child

Typically, a child stays in the hospital for 2 to 3 days after an appendectomy, a little longer if the appendix burst before it was removed. Many hospitals allow at least one parent to stay with the child throughout the day and overnight.

When your child is discharged from the hospital, you'll get instructions on home care and when to come back for a follow-up visit with the doctor (usually within a few weeks).

Other things to think about as your child recovers at home:

  • Eating and drinking: There probably won't be any food or drink restrictions after the surgery, but it's likely that your child won't have much of an appetite at first.
  • Caring for the incision: Be sure to keep the area clean and watch for signs of infection. Call your doctor if you notice any redness or swelling around the incision, or your child develops pain or a fever greater than 101º F (38.3º C).
  • Returning to school: The doctor will tell you when your child can return to school and resume normal activities. In many cases, that's within a week of surgery, longer if the appendix burst.
  • Resuming physical activity: The doctor might recommend that your child not participate in gym class, sports, and other physical activities for a few weeks.

With a little rest and care, most kids recover from appendicitis and an appendectomy with little difficulty.

When your child is having any kind of procedure or surgery, it's understandable to be a little uneasy. But it helps to know that appendectomies are common procedures and complications are rare. However, as with most procedures, there are some risks, which your doctor will review with you. If you have any other questions or concerns, speak with your doctor.

Reviewed by: Kate M. Cronan, MD
Date reviewed: July 2009