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Appendectomy: Surgical Approaches, Procedure Steps, and Recovery Expectations

Preoperative Preparation

  • Diagnostics: Blood work (CBC, CRP), urinalysis, and imaging (ultrasound or CT) to confirm diagnosis.
  • Consent and counseling: Surgeon explains procedure, risks, benefits, and alternatives.
  • Preoperative fasting: Typically 6–8 hours for solids, 2 hours for clear liquids.
  • Antibiotic prophylaxis: Administered within 60 minutes of incision.

Anesthesia

General anesthesia is standard, ensuring complete unconsciousness and muscle relaxation.

Surgical Approaches

Laparoscopic Appendectomy (Preferred When Feasible)

  • 3–4 small incisions (5–12 mm)
  • Camera and instruments inserted through ports
  • Appendix identified, encircled with endoloops or stapler, divided, and removed in an endoscopic bag
  • Advantages: less pain, faster recovery, better cosmesis, lower wound infection rate

Open Appendectomy

  • Single 2–4 inch incision in right lower quadrant (McBurney's point)
  • Direct visualization and removal
  • Indicated for: perforated appendix with extensive contamination, dense adhesions, obesity limiting laparoscopic access, surgeon preference/experience

Common Procedural Steps (Both Approaches)

  1. Appendix mobilized from mesoappendix
  2. Base ligated (sutures, clips, stapler, or energy device)
  3. Appendix divided and removed
  4. Stump inspected for hemostasis
  5. Peritoneal cavity irrigated if purulent
  6. Drains placed selectively for abscesses
  7. Fascia and skin closed

Recovery Timeline

MilestoneLaparoscopicOpen
Hospital stay0–1 day (often outpatient)1–3 days
Return to light activity3–5 days1–2 weeks
Return to full activity1–2 weeks3–4 weeks
Pain intensityMild–moderateModerate–severe

Postoperative Care

  • Pain management: multimodal (acetaminophen, NSAIDs, limited opioids)
  • Early ambulation encouraged
  • Diet advanced as tolerated
  • Wound care instructions
  • Follow-up in 1–2 weeks

Note: For perforated appendicitis, longer IV antibiotics and extended hospitalization may be needed regardless of approach.

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