Appendicitis Treatment

How appendicitis is treated? 

The appendicitis is considered as an medical emergency where the chances of burst appendix increases significantly after 24 hours. At most of the places surgery is considered is mainstay of appendicitis treatment. Antibiotics may also be given to treat an infection or to prevent infection after the surgery.

Surgery: The treatment of choice for appendicitis is the surgery done to remove inflamed appendix which is called as appendectomy. Surgery is recommended in confirmed cases, where fever and pain are continuous or where there is development of complications. Early surgery reduces the chances of a burst appendix in appendicitis treatment.

The surgery is done under general anesthesia and can be done in two ways:

Laparoscopic surgery: here few small incisions are made in the abdomen from which a thin tube-like device with a camera called a laparoscope is inserted which has an instrument that cut the appendix and takes it out. This surgery has fewer chances of complications like infection, better cosmetic appeal due to small incision and shorter recovery time. This is the best appendicitis treatment.

Laparotomy surgery: this surgery doesn’t use the laparoscopic device and a comparatively larger cut (5- 10 centimeters) is made to cut open the abdomen in the right lower region. This surgery is preferred in cases with complications such as an abscess, rupture of the appendix, and peritonitis- where the infection spreads in the abdomen.

Recovery time: after a successful surgery a person is generally made to stay for 1- 2 days in the hospital.

Doctors advise restricting physical activity for several days in both the surgery:

• Laparoscopic surgery: 3 to 5 days

• Laparotomy surgery: 10 to 14 days

Complications after surgery: common complications encountered are:

• Wound infection- most common complication

• Distention and dilatation of small bowel loops called ileus

• Pneumonia- an infection in the lungs

Complication rates of surgery are generally very low with studies suggesting less than 1% risk of death and less than 14% of other post-surgery issues. This is slightly higher in cases of appendicitis with complications.

What is done if the surgeon finds a normal appendix during surgery?

In some of the cases strongly suspected as appendicitis, the surgeon finds a normal appendix during the surgery. In many of these cases, the surgeon prefers to remove the appendix to avoid any future possibility of appendicitis. In some cases, the surgeon finds a different pathology and treat it surgically.

How the complication of appendicitis is treated?

The appendicitis treatment of complications is as per the type of complication.

• Burst appendicitis with peritonitis: usually these cases are immediately taken for surgery as peritonitis could lead to death. These patients are taken for laparotomy surgery where the appendix is removed and the peritoneum is cleaned to prevent the spread of infection.

• Appendiceal abscess: these patients are treated by putting drain/tube in the site of abscess generally before the surgery and sometimes during surgery. The tube is put through the abdominal wall. It is kept inside for about 2 weeks which drains the abscess gradually over this period while the patient is given antibiotics to treat the infection. After about 6 to 8 weeks when the infection and inflammation are under control the surgeon removes the appendix by surgery in appendicitis treatment.

Can surgery be avoided in cases of appendicitis treatment? Can antibiotics prevent the need for surgery in appendicitis?

Several recent studies suggest that the uncomplicated cases of appendicitis can be treated with antibiotics with most of the people not requiring appendectomy surgery during the first year. Amongst the smaller group of people needing surgery no significant complications were developed during this period. These cases have to be accounted for uncomplicated by CT findings.

Late recurrence of appendicitis treatment in these patients even after 5 years of the period was found to be less than 40%. Still, the mainstay of the treatment remains surgical removal of the swollen appendix and only a few centers going for non-surgical appendicitis treatment presently.

A person must understand and discuss with his doctor the pros and cons of surgical and non-surgical methods before opting for his preferred appendicitis treatment option.

What are the things to remember during the post-surgery recovery period at home?

1. Restrict doing strenuous physical activity for several days after the surgery:

• Laparoscopic surgery: 3 to 5 days

• Laparotomy surgery: 10 to 14 days.

2. Take a good amount of rest which helps the body to recover.

3. Gradually increase the level of physical activity starting from short walks to doing daily routine work and then strenuous activities like gym or sports over a period of several days to weeks.

4. Discuss with the doctor the expected time of recovery, follow up and start of work/job.

5. Inform the doctor if pain medicine is not helpful or you develop any new symptoms like fever, cough, etc.