What Is an Open Appendectomy?

An open appendectomy is a surgical procedure that involves the removal of the appendix.

An appendix is a small, finger-like structure at the junction of the small and large intestine. The function of the appendix is largely unknown and its removal seems to not cause any observable problems. However, its infection can be painful.

An appendectomy is a surgical procedure that involves the removal of the appendix. The appendectomy can be performed in two ways:

1. Open appendectomy: The surgeon makes a cut of about 2 to 3 inches over your abdomen (laparotomy) to remove your appendix. 
2. Laparoscopic appendectomy: The appendix is visualized through a long, tube-like camera (laparoscope) after making multiple small cuts in the abdomen. Then the appendix is removed with the help of surgical tools.

Your doctor will advise you to go for an appendectomy if your appendix gets infected, making it swollen (inflamed) and causing pain. This condition is known as appendicitis. Appendicitis signs and symptoms include:

• Aching pain around the belly button/navel that shifts to the lower right abdomen
• Sharp pain that increases by movements such as walking or coughing
• Nausea, vomiting, loss of appetite
• Fever
• Constipation
• Inability to pass gas
• Abdominal swelling
• Diarrhea

Initially, your doctor will treat your appendicitis with antibiotics. But if you get frequent attacks of appendicitis (chronic appendicitis) or the doctor suspects that the infection has spread deeply and extensively, he/she will plan an appendectomy. 

If the infected appendix is not removed at the right time, it might turn into a pus-filled structure (abscess), or it might burst and infect the entire abdomen (peritonitis), which is a life-threatening condition.

Most of the time, an appendectomy is done on an emergency basis.

To check the intensity of the infection, your surgeon might ask you to undergo a few blood tests and investigations like ultrasonography (USG)/CT scan.

When you get admitted, you will be instructed not to eat or drink (nothing by mouth) for at least eight to 10 hours or until your surgeon advises you to do so.

You will receive injections for your nausea/vomiting, as well as antibiotics and saline solutions given intravenously. 

• You will be given general anesthesia, which numbs your entire body and makes you sleep throughout the procedure to make it painless.
• Based on the severity of the infection, your surgeon will decide to go either for an open appendectomy or laparoscopic appendectomy.
• By either method, once the appendix is identified, it is tied off and removed. 
• The surgical wound is then cleaned with an antiseptic solution, closed with surgical threads (sutures), and bandaged.

• You will be shifted to the surgical ward and observed for several hours after appendectomy. 
• If you had a laparoscopic appendectomy, you may be sent home on the same day of the surgery or on the next day in case of an open appendectomy. 
• You will be given painkillers and antibiotics intravenously until you get discharged from the hospital and advised to continue them orally for the next three to seven days.
• You will be told to follow-up with your doctor, generally, after one week. Until then, you need to keep an eye on your wound to check if it is healing properly. 
• You can resume your normal activities like walking, within a day or as advised by your doctor.

An appendectomy is a major abdominal surgery that can lead to the following complications:

• Internal bleeding
• Infection of the surgical wound
• An abdominal abscess (pus in the abdomen)
• Enteric injury (injury to the intestine)
• Fistula (formation of a cavity that discharges fluid)

Other complications that can happen in the long-term include:

Incisional hernia: Bulging of the surgical scar that happens due to the surgical cut not healing after appendectomy.

Stump appendicitis: Frequent infections due to a small piece of the appendix that was accidentally left in the abdomen during the operation.

Small-bowel obstruction: A partial or complete blockage in the small intestine due to the surgical scar from the appendectomy. The rate of bowel obstruction after laparoscopic appendectomy is lower than after open surgery. It occurs in approximately 0.89% of patients who underwent laparoscopic appendectomy and in 3.21% after open appendectomy.

To allow the complete healing of the internal and external surgical wounds, you need to avoid strenuous physical activities like vigorous exercises or lifting heavy weights for about four to six weeks after the appendectomy.