What is the appendix?

The appendix is a small, tubular structure that comes off part of your bowel (called the colon or large intestine). It is located in the lower right side of your tummy.

What does the Appendix do?

The appendix has no function. Removing the appendix does not cause any problems.

What is appendicitis?

Appendicitis occurs when the appendix becomes swollen and inflamed. If left untreated, the appendix can burst (perforate) or form a collection of infected fluid in your tummy (abscess). This can make you very unwell.

How common is appendicitis? 

Appendicitis is very common. Between 5 to 10% of people will develop appendicitis in their lifetime. Appendicitis is most common in people 20-30 years old, but it can occur at any age.

What are the symptoms of appendicitis?

Most people with appendicitis will experience tummy pain. This often starts as an ache around the belly button area. The pain often moves to the lower right corner of your tummy. People with appendicitis often feel sick and do not feel like eating or drinking. You may experience high temperatures.

How is appendicitis diagnosed?

In some people the diagnosis of appendicitis is made by examining their tummy and taking blood tests. In some people it can be harder to work out if there is appendicitis. We often ask for a scan. Types of scan include:

• Ultrasound – Some jelly and a probe are placed on the surface of your tummy. You can drink clear fluids (water, black tea or black coffee) before the scan. You cannot have anything to eat 6 hours before the scan.
• CT scan – This is a whole-body x-ray. A CT scan uses high doses of x-rays (radiation).
• MRI scan – Very few people will have an MRI scan. We ask for this scan in younger people or pregnant women when we want to avoid using x-rays.

How do you treat appendicitis?

 There are two ways of treating appendicitis.

• With an operation
• With antibiotics

A surgeon will discuss which is the best option for you.

How do you treat appendicitis with an operation?

Most people will have their appendix removed with keyhole surgery (called a laparoscopic appendicectomy). This is always performed under general anaesthetic (where you are put to sleep).

How do you treat appendicitis with antibiotics?

In some cases, we can manage appendicitis with antibiotics alone. This involves taking a course of tablet antibiotics at home for 7 to 10 days. In severe cases, you may be admitted to hospital and be given antibiotics through a drip (intravenous antibiotics).

What are the advantages of surgery to remove the appendix?

• The operation is able to quickly and effectively treat any infection inside your tummy.
• The appendix is removed and you will not get appendicitis again in the future.

What are the disadvantages of surgery to remove the appendix?

• The operation to remove the appendix is safe but there are some small risks associated with anaesthesia and surgery.
• You may have to spend one or two nights in hospital recovering from the operation.
• A complete recovery from the operation can take several weeks and can affect your ability to work, drive and do certain activities.

What are the advantages treating appendicitis with antibiotics?

• You avoid an operation.

What are the disadvantages treating appendicitis with antibiotics?

• The treatment with antibiotics can fail. This means you will have to come back into hospital. You may need to have your appendix removed after all. Antibiotics treatment can fail in 10% of cases.
• You will still have your appendix. This means you could get appendicitis again in the future. This happens in about 12 to 24% of people.
• Some people chose to have their appendix removed once they have recovered from appendicitis. This means you have an operation several months after having had appendicitis.

What does keyhole surgery involve?

You will be fast asleep (under a general anaesthetic). Your surgeon will make 3 small cuts on your tummy (1.5cm or less). A camera and instruments are then put into the tummy and your appendix is removed from the bowel.

When will I have my operation?

Emergency appendix operations take place in the emergency operating theatre. The order of the emergency list changes many times throughout the day. This means we cannot tell you exactly when your operation will take place. Sometimes there can be a long wait for your operation. We will try to keep you informed of any changes.

Will I need to be starved before my operation? 

You cannot eat anything for four hours before your operation. You can drink water up to two hours before your operation. If you have a long wait, we will give you fluid through a drip in your arm.

Will any other procedures be performed during my operation?

Possibly. These include:

• Drain – If we are worried about collections of fluid forming inside your tummy after the operation, we sometimes leave a drain. This is a thin plastic tube that sticks out of one of your wounds. This is connected to a bag which collects the fluid. If a drain is used, it usually stays for one or two days after your operation. The drain is often removed on the ward with little discomfort.
• Open operation – If the appendix is very inflamed or there is a problem during the operation, it may not be possible to perform the operation with keyhole surgery. Your surgeon will make a cut on your tummy – either below the belly button or in the right hand corner of your tummy.

If you have an open operation your recovery will be longer. It is unusual that we cannot remove your appendix with keyhole surgery.

• Another procedure – At the time of your operation we can sometimes discover that that you do not have appendicitis and that another condition has caused your symptoms. This is unusual.  Conditions include bowel inflammation or if you are a woman, a gynaecological problem. If discovered, we will try to treat this during your operation.  

Are there any complications from an operation to remove the appendix?

Keyhole surgery to remove the appendix is generally a safe operation. Most people will not experience a problem following surgery. Potential risks include:

• Wound infection – This usually happens once you are at home. The skin around the wounds may go red and painful, or the wounds may leak smelly fluid. This can be managed with antibiotics.
• Fluid collections – Several days after your operation, collections of infected fluid can form inside your tummy. This is more common if you had severe appendicitis. If you have a fluid collection you will experience pain, feel unwell and have high temperatures. This can be managed with antibiotics or, occasionally, a drain inserted under x-ray.
• Damage to a structure inside the tummy – This is very rare. If a problem is encountered at the time of surgery, this can often be fixed with keyhole surgery. Sometimes this requires an open operation. Rarely, damage is not seen at the time of the operation, and a second operation within days of the original operation is required to deal with it. If you do suffer this rare complication, it will prolong your stay in hospital.

After your operation

How soon can I go home after my operation?

This depends on your how severe your appendicitis was, how physically fit you are and your home circumstances. Some people can go home on the day of surgery. Most people will stay one or two nights in hospital.

Will I have pain after my operation?

Most people will have some discomfort after their operation. You will be offered regular painkillers by the nursing staff on the wards. If you have pain in between these times, you can ask for more pain relief. It is important that you tell us if your pain is not well controlled.

Will I go home with painkillers?

Most people will need regular paracetamol and ibuprofen (if you are able to take this) for the first few days following surgery. We often supply a stronger painkiller (such as codeine) to take as you need. You should be comfortable enough to do gentle activities. You should take painkillers as directed on your discharge letter.

Will I need antibiotics?

This depends on how severe your appendicitis was. Some people will not need any antibiotics after surgery. Some people will be prescribed a course of antibiotics for several days. Your surgeon will tell you this after your operation.

Will I need to have somebody to look after me at home?

Yes. After surgery many people feel a bit sore and tired. It is helpful to have someone who can help make meals, do the shopping and run errands for you until you are fully mobile.

What will I be able to do when I go home?

It is normal to feel a bit of tummy bloating, tiredness, and be a bit sore for several days. With keyhole surgery, the pain can often be felt in the shoulder. Your tummy may remain a little swollen for one to two weeks afterwards. This is quite normal after this surgery. You should rest and eat only light meals for the first day or two. You should avoid any alcohol while taking painkillers stronger than paracetamol.

You may be constipated; this is as a result of missing normal meals around the time of your surgery and can be a side effect of some painkillers. This should settle by itself. If not, you can use a gentle laxative that you can buy from any chemist.

You will probably not feel like leaving the house for the first couple of days, but make sure you walk about within the house or around the garden every couple of hours during waking hours. This will keep the blood circulating in your legs and reduce the chance of a blood clot forming in the legs.

What should I do with my wounds?

Your wounds will be covered by a dressing. The dressings are waterproof and you can shower with the dressings on. If your wounds are clean and dry after 4 days, the dressings can be removed. For the first couple of days, it is usual to have slight blood leakage on to the dressing. Extra dressings can be purchased at most chemists if you feel you need them.

Will I need to any have stitches removed?

Most surgeons use skin stitches that dissolve by themselves. We will tell you if this is not the case.

How will I know if my wounds are healing properly?

Most wounds heal without problems. You do not need to visit your GP or practice nurse unless you are worried or think there is a problem.

It is normal for a wound to feel hard and tender for several weeks. It is quite normal for you to feel a lump under the wound, as this is the healing ridge of tissue. The scar will look red, and often remains red for many months.

When will I be able to go back to work?

This depends on your type of work, and whether you had keyhole surgery or open surgery.

A desk job can be returned to after a week or two if you have had keyhole surgery, or around four weeks with open surgery. A heavy manual job will require longer off work: around three to four weeks off for keyhole surgery, and six to eight weeks for open surgery. Please ask us for a fit note (Statement of Fitness for Work) on the day of your discharge.

When can I start to drive again? 

Once you can comfortably use all the controls in the car and when you are no longer taking strong painkillers. You must be able to perform an emergency stop and be able to turn round in your seat to safely reverse the car. We usually recommend not driving for three or four days after keyhole surgery, and around ten days for open surgery. 

It is always best to check with your insurance company to see if they have any specific rules related to the type of operation you have had done. This is particularly important for professional drivers, e.g., taxi drivers, HGV drivers.

Will I be given a hospital review appointment after my operation?

Most people will make a straightforward recovery. We do not routinely see patients after an appendix operation.

Symptoms requiring you to seek medical attention

If you experience any of the following within the first week after your incision and drainage, you should contact the Surgical Assessment Unit (see below for contact details):

• Severe pain
• Bleeding: if your dressings become soaked in blood, and the bleeding does not stop after applying firm pressure for 20 minutes, you should contact the hospital
• Increased discharge and swelling: this might mean that the abscess need further treatment.

If you are experiencing any of the following symptoms please get in contact, using the details below:

• Unable to eat or drink.
• Severe pain
• Fever
• Feeling unwell
• Wound problems

Who can I contact if I feel something isn’t right after my appendix operation?

If your procedure was at Wexham Park Hospital	Call: 07468 354 436    Available Monday to Friday 9am to 5pm 07826 921 319 Available 10pm to 7am
If your procedure was at Frimley Park Hospital	Call: 07990 528 061        Available 24 hours
If you cannot get in contact, please call 111
If you feel seriously unwell, call 999 or go to the nearest Emergency Department

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Please contact the patient advice and liaison service (PALS)

Frimley Park Hospital 0300 613 6530

fhft.palsfrimleypark@nhs.net

Heatherwood Hospital and Wexham Park Hospital 0300 615 3365

fhft.palswexhampark@nhs.net