What Is Transvaginal Appendectomy?

In treating acute appendicitis, transvaginal appendectomy, which involves removing the appendix through the vagina, is one option.

Transvaginal appendectomy is an evolving surgical procedure that involves the removal of the appendix through the vaginal route.

It is one of the three types of appendectomy—apart from traditional open appendectomy and laparoscopic appendectomy—that is done to treat acute appendicitis.

The decision to opt for transvaginal appendectomy over the other two methods remains at the discretion of the patient as also on the surgeon’s expertise.

Transvaginal appendectomy can be done in either of the two ways:

• Natural orifice transluminal endoscopic surgery (NOTES) alone
• A combination of NOTES and laparoscopy

The advantages of transvaginal appendectomy via NOTES over other types of appendectomy include the following:

• Low chances of infection and hernia
• Less pain after surgery (hence minimal painkillers required)
• Shorter recovery period
• No visible scars

A doctor may recommend the patient against transvaginal appendectomy and instead prefer laparoscopic appendectomy or open appendectomy if the patient

• Has a ruptured appendix
• Is pregnant
• Has delivered in the last two months
• Has a history of 
  • Pelvic inflammatory disease (PID)
  • Endometriosis (a painful condition in which tissues of the uterus grow anywhere in the abdomen)
  • Inflammatory bowel disease (IBD)
  • Retroflexed or retroverted uterus (tilted uterus)

If complications arise during the surgery, the doctor can decide to convert transvaginal appendectomy to either the laparoscopic or open approach.

Before the surgery

• The patient is evaluated if they are fit for the surgery and general anesthesia. They are not allowed to eat or drink anything for 8-12 hours, except for a few sips of water with the necessary medicines, before the surgery.

During the surgery

• The patient is given general anesthesia to make them feel relaxed throughout the procedure.
• Next, the surgeon introduces an instrument known as a speculum into the vagina to visualize the interior of the vagina.
• The surgeon then makes an incision in the vaginal wall. 
• The surgeon inserts an endoscope (a long tube-like camera) through the incision and directs it further to visualize the appendix in the abdomen.
• Once the appendix is identified, the surgeon fills the abdominal cavity with air and cuts the appendix with the help of instruments inserted through the endoscope. The surgeon retrieves the appendix in a bag. Hemostasis (arresting of bleeding) is done.
• The surgeon then removes the appendix out of the vagina.
• The surgeon sutures the incision at the vagina.

After the surgery

• The patient is shifted to the general ward and observed for several hours after the surgery.
• A liquid diet can be started 12-24 hours after the surgery.
• Painkillers and antibiotics are initially given intravenously (IV) and later by mouth.
• After regular monitoring, the patient is discharged usually after one or two days.
• Patients are generally recommended to avoid sex for about two weeks to one month after the surgery.
• The patient needs to follow-up with the surgeon seven days after the discharge and later as advised.

The uterus is only passed by and remains uninjured while the endoscope moves toward the appendix, so it is unlikely that the surgery will affect the fertility of the patient.

The possible complications include the following:

• Bowel or rectal injury
• Abdominal adhesions (bands of scar-like tissue between two or more organs)
• Abdominal abscess (collection of pus in the abdomen)