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Appendectomy: Indications, Procedure & Recovery

Appendectomy is surgical removal of the vermiform appendix, most commonly for acute appendicitis.

Indications

  • Acute appendicitis (clinical ± imaging diagnosis).
  • Interval appendectomy after conservative management of appendiceal mass.
  • Incidental during other pelvic surgery (controversial).
  • Appendiceal neoplasm (carcinoid, adenocarcinoma).

Surgical Approaches

  • Laparoscopic (standard): 3 ports; less pain, shorter stay, faster return to work.
  • Open: McBurney incision; for perforated with extensive contamination, adhesions, or no laparoscopy available.
  • Single‑incision (SILS) / NOTES: Cosmetic; longer OR time.

Key Operative Steps

  1. Identify appendix (taenia coli convergence).
  2. Mobilize mesoappendix; divide vessels (ligature/energy device).
  3. Base ligation: Endoloops, stapler, or suture; invaginate stump if inflamed.
  4. Irrigation if purulent; drain if abscess.
  5. Specimen in retrieval bag.

Recovery

  • Uncomplicated laparoscopic: Discharge same day/next; oral diet immediately; resume light activity 3–5 days; full activity 2–3 weeks.
  • Perforated: IV antibiotics 3–5 days; longer hospitalization.
  • Complications: SSI (5–15% perforated), intra‑abdominal abscess, ileus, stump leak.

Post‑Op Red Flags

  • Fever >38.5°C, worsening pain, vomiting, no flatus/stool >48h, wound erythema spreading.

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