- Acute Appendicitis: Inflammation of the appendix causing severe abdominal pain, typically starting around the navel and moving to the lower right abdomen.
- Chronic Appendicitis: Mild, recurring inflammation of the appendix that causes persistent pain in the lower right abdomen.
- Appendiceal Tumour: Growth or mass detected in the appendix during routine imaging or investigation of other symptoms.
- Preventive Removal: Removal of the appendix during other abdominal surgery in specific cases to prevent future complications.
Appendectomy
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
An appendectomy is a surgical procedure to remove the appendix, a small, tube-shaped organ attached to the large intestine. It is typically performed as an emergency operation when the appendix becomes inflamed (appendicitis) to prevent complications such as rupture and infection in the abdomen. Prompt removal reduces the risk of further complications and supports a smooth recovery.
Indications for Appendectomy
An appendectomy is performed when specific signs and symptoms suggest appendicitis or other appendix-related conditions that require removal. These include:
Benefits of Appendectomy
The surgical removal of the appendix provides several advantages for patients with appendicitis or related conditions.
Prevention of Severe Infection
Removing the inflamed appendix before it ruptures reduces the risk of peritonitis and other life-threatening infections in the abdominal cavity
Pain Relief
Surgery eliminates the severe pain of appendicitis and prevents recurrent pain in cases of chronic appendicitis
No Long-term Digestive Impact
The appendix has no function in digestion, and its removal does not affect digestive processes or overall health
Efficient Recovery
Most individuals recover well after surgery, with a short hospital stay and a return to normal activities within a few weeks
Surgical Techniques
Laparoscopic Appendectomy
This minimally invasive technique uses three to four small incisions in the abdomen. The surgeon inserts a camera and special instruments through these openings to remove the appendix. Recovery is typically faster with this method, and scarring is minimal. The procedure usually takes 45-60 minutes under general anaesthesia.
Open Appendectomy
This traditional method involves making a single incision (about 2-4 inches long) in the lower right abdomen. The surgeon directly accesses and removes the appendix through this opening. This technique may be preferred in cases of severe infection, rupture, or when the appendix is difficult to access. The procedure typically takes 30-45 minutes.
Preparing for Surgery
- Medical Evaluation: A physical examination and medical history review are conducted. Blood tests check for infection and other health markers. Imaging tests such as a CT scan or ultrasound may be used to confirm appendicitis and guide the surgical approach.
- Medication Review: All current medications are assessed. Blood-thinning medications may need to be paused several days before surgery. Antibiotics are usually started before the procedure if an infection is present.
- Fasting Guidelines: No food or drink should be consumed for 6–8 hours before surgery to reduce the risk of aspiration during anaesthesia. Clear fluids may be allowed up to 2 hours before the procedure.
Step-by-Step Procedure
- Anaesthesia Administration: General anaesthesia is given through an intravenous line, and vital signs are monitored throughout the procedure. A breathing tube is placed to maintain oxygen levels during surgery.
- Surgical Site Preparation: The abdomen is cleaned with an antiseptic solution, and sterile drapes are placed around the surgical area. The incision site(s) are marked based on the surgical approach.
- Accessing the Appendix: In laparoscopic surgery, carbon dioxide gas inflates the abdomen to create space for instruments. In open surgery, muscles and tissues are carefully separated to expose the appendix. The appendix is identified and isolated from surrounding structures.
- Appendix Removal: The blood supply to the appendix is sealed with surgical clips or ties. The base of the appendix is cut and secured to prevent leakage, and the appendix is removed through the incision(s). Any infected fluid is cleared from the surgical area.
- Closure: The incision(s) are closed with dissolvable stitches or surgical staples, and sterile dressings are applied. Anaesthesia is gradually reversed, and the breathing tube is removed.
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Post-Surgical Care and Recovery
Immediate Care
Patients stay in recovery for a few hours while vital signs, pain levels, and wounds are monitored. Most go home within 24 hours after laparoscopic surgery or 48 hours after open surgery. Pain medication is provided as needed, with most switching to over-the-counter options within a few days.
Activity & Movement
Walking is encouraged within 24 hours to support circulation. Light activities can resume after a week, while heavy lifting (over 10kg) should be avoided for 4–6 weeks. Most return to work within 1–3 weeks.
Wound Care & Monitoring
Dressings remain for 48 hours unless advised otherwise. Showering is allowed after this period, but incision sites should be patted dry. Any redness, swelling, or drainage should be reported.
Follow-up
A follow-up appointment within 1–2 weeks checks wound healing and removes any non-dissolvable stitches. Further visits depend on recovery progress.
Potential Risks and Complications
While appendectomy is common, potential risks include bleeding, infection, and internal adhesions that may lead to bowel obstruction. A small risk of intra-abdominal abscess exists, especially if the appendix was perforated. Some patients experience temporary constipation or diarrhoea, and in rare cases, a hernia may develop at the surgical site.
Frequently Asked Questions
When can I resume a normal diet?
Clear fluids are allowed once you are fully awake after surgery. Most patients progress to regular food within 24-48 hours, as tolerated. A gradual return to a normal diet helps prevent digestive discomfort.
What happens if my appendix ruptures before surgery?
A ruptured appendix requires thorough cleaning of the abdominal cavity during surgery. Recovery may take longer, and a longer course of antibiotics is typically needed. The surgeon will monitor closely for signs of infection during recovery.
Can appendicitis be treated without surgery?
In some cases, mild appendicitis can be managed with antibiotics if there is no risk of rupture. However, this approach may not always be effective, and appendicitis can return. Surgery is the most reliable way to fully resolve the condition and prevent complications such as perforation or abscess formation.
Partnered Programmes & Insurance Plans
For Singaporeans, Singapore Permanent Residents and Foreigners. Please speak to our friendly clinic staff about using your insurance plans.
Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 20 years of experience in clinical practice.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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Singapore 329563
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