Appendicectomy is the surgical removal of the vermiform appendix either due to clinically or radiologically suspected appendicitis or alternative pathology (i.e tumour, mucocoele etc). The operation is performed under general anaesthesia with the patient in the supine position. Both open and laparoscopic appendicectomy are acceptable, local practice may influence the surgeon’s decision.
Open: A Gridiron or Lanz incision is made in the right iliac fossa. The layers are divided and the peritoneum is opened. The peritoneal cavity is entered and the appendix is identified, ligated, and excised. If the appendix has perforated, a washout is performed. The peritoneum is closed and the layers are closed with absorbable sutures.
Laparoscopic: in general, three or four small port incisions are made in the abdominal wall, the ports and camera are inserted following the introduction of a Pneumoperitoneum. The appendix is identified, ligated, and removed. The port sites are subsequently closed.
Recent Cochrane review recommends that all patients undergoing appendicectomy should be prophylactically administered antibiotics. If the appendix has perforated antibiotics may need to be continued over a number of days (either intravenously or oral).
If an intra-abdominal mass is found (commonly following a perforated appendix) the decision may be made to manage this with antibiotics. Some surgeons may elect to subsequently perform an interval appendicectomy.
If the appendix is found to be macroscopically normal and the operation is performed open, it is best practice to perform the appendicectomy for two reasons: the first is that the appendix may be microscopically inflamed and the second being if a patient is noted to have either a Gridiron or Lanz incision it is assumed (rightly or wrongly) that they have previously undergone appendicectomy.
If the operation is performed laparoscopically and the appendix is noted to be normal, the decision to perform the appendicectomy is less clear. If, for example in a young female blood is noted in the pelvis (commonly from a ruptured ovarian cyst) the diagnosis is clear and an appendectomy would confer additional unnecessary risks. If no other obvious cause is found an appendicectomy may be indicated as a proportion will be histologically inflamed.
Once the operation has been performed, the appendix will be sent to the histopathology lab for examination.