The appendix is a small, nonessential organ attached to the large intestine near its connection to the small intestine. When the appendix becomes inflamed or infected, it is usually removed. Surgical removal of the appendix, known as an appendectomy, can be performed with an open procedure or using laparoscopic instruments. Risks and side effects vary depending on the type of procedure, whether the appendix has ruptured, and other factors. Most side effects are mild and temporary, although serious complications sometimes occur.
Abdominal Pain and Discomfort
Abdominal pain after an appendectomy is expected, but the severity varies among individuals. Postoperative pain typically decreases over time, and surgeons routinely prescribe pain medication as needed. Holding a pillow against your stomach when coughing or getting up can help minimize your pain with these activities. Abdominal discomfort due to bloating is also common after a laparoscopic appendectomy. It occurs because gas is pumped into the abdomen during the procedure to enable the surgeon to maneuver the instruments and see your organs clearly. This gas can also sometimes cause referred shoulder pain. Gas-related side effects are short-lived, as the gas dissipates in the first 24 to 48 hours after a laparoscopic procedure.
Since an appendectomy involves manipulation of the bowel, you might experience diarrhea for a few days after the procedure. Constipation can also occur, primarily due to narcotic pain medicines that may be prescribed. Ileus -- temporary lack of normal bowel contractions -- can occur with any type of abdominal surgery. Symptoms include nausea, vomiting and abdominal distention. This condition normally resolves on its own within a few days, although it may prolong your hospital stay. Less commonly, a temporary bowel obstruction can occur due to bowel swelling near the site where the appendix was removed. This situation also typically resolves with a few days of appropriate treatment in the hospital. Scar tissue formation after an appendectomy can increase the risk of a bowel obstruction years after the procedure, although this is a rare complication.
A surgical wound infection is the most common, serious complication after an appendectomy, according to the American College of Surgeons. These infections are more common with an open appendectomy compared to a laparoscopic procedure. People who smoke may be an increased risk for postoperative wound infections. Rupture of the appendix before surgery also increases the risk for an infection at the site of the surgical incision. Most surgical wound infections are treated successfully with antibiotics, but other treatment may be needed.
An emergency appendectomy is performed with suspected appendicitis because if the appendix ruptures, bowel bacteria escapes into and infects the abdominal cavity. This infection, known as peritonitis, is a serious complication of appendicitis. However, peritonitis can also develop as a rare complication of appendix removal surgery. An unnoticed, accidental nick of the bowel during surgery is usually the culprit when peritonitis develops after an appendectomy. Formation of an abscess -- a pocket of infection -- in the abdomen near the site where the appendix was removed is another possible, rare complication after an appendectomy. Development of an abscess in the abdomen after appendix removal may require a second surgery to drain the abscess.
General Side Effects of Surgery and Anesthesia
Certain side effects are possible with any abdominal surgical procedure, including an appendectomy. These potential but uncommon complications include: -- pneumonia -- blood clot formation -- development of a hernia -- heart attack during or after surgery -- reaction to anesthesia -- excessive bleeding
Rarely, serious complication can lead to death. Some complications, length of stay in the hospital and number of deaths are lower with a laparoscopic appendectomy compared to an open procedure, according to an analysis of the medical research published in October 2010 by the "Cochrane Database of Systematic Reviews." However, there are situations in which an open appendectomy is preferable to a laparoscopic procedure.
Warnings and Precautions
Most people undergoing an appendectomy experience only mild, short-term side effects and return to their regular activities within 2 to 4 weeks. However, serious side effects are possible, so it's important to watch for warning signs. Your doctor will give you specific postoperative instructions, but the American College of Surgeons recommends contacting your doctor if you experience: -- persistent, worsening or severe abdominal pain -- repeated vomiting -- a fever higher than 101 F -- watery diarrhea or no bowel movements for 3 days -- swelling, redness, bleeding or foul-smelling drainage from your surgical incision
Reviewed and revised by: Tina M. St. John, M.D.
Is This an Emergency?
- Annals of Surgery: Bowel Obstruction Following Appendectomy: What is the True Incidence?
- Merck Manual Professional Version: Ileus (Paralytic Ileus; Adynamic Ileus; Paresis)
- Cochrane Database of Systematic Reviews: Laparoscopic Versus Open Surgery for Suspected Appendicitis
- Annals of Surgery: Risk Factors for Adverse Outcomes After the Surgical Treatment of Appendicitis in Adults
- American College of Surgeons: Appendectomy
- Journal of Medicine and Life: Laparoscopic Surgery Complications: Postoperative Peritonitis
- Canadian Journal of Surgery: Infectious Complications Following Laparoscopic Appendectomy
- General Surgery: Principles and International Practice, 2nd Edition; Kirby I. Bland, et al.
- Essentials of General Surgery, 5th Edition; Peter F. Lawrence
- Complications in Surgery and Trauma, 2nd Edition; Stephen M. Cohn and Matthew O. Dolich