Laparoscopic appendicectomy

Here is what a laparoscopic appendicectomy — keyhole removal of your appendix — actually involves. Three small cuts are made in your abdomen, each roughly the size of your fingernail. Through these, a tiny camera and fine instruments are passed so the appendix can be located and gently removed. You will be completely asleep under a general anaesthetic the whole time, so you will not feel a thing. The operation usually takes between 30 and 60 minutes. The keyhole approach is the modern standard for most appendicectomies — in published series, it is associated with less post-operative pain, a lower risk of wound infection, and a quicker return to everyday life than the older large-cut (open) method.

You may be having this operation for one of these reasons:

• Acute appendicitis — sudden inflammation of your appendix — confirmed by your doctor's examination along with a CT scan or ultrasound to make sure the diagnosis is right
• Perforated appendicitis — where your appendix has already burst. This sounds alarming, but the keyhole approach is still used; a thorough wash-out of the inside of your abdomen is also performed with warm salt water to clear any infection that has spread
• An appendix mass or abscess (a contained pocket of infection around the appendix) — sometimes the safest approach is to treat the infection first with antibiotics or drainage, let things settle for a few weeks, and then remove the appendix in a calmer, planned operation called an interval appendicectomy
• Chronic or recurrent appendicitis — if you have had ongoing or repeated episodes of appendix pain that keep coming back, removal is the only reliable solution
• Removal of the appendix at the same time as another keyhole abdominal operation you are having
• An appendix tumour or mucocele (a mucus-filled swelling of the appendix) that needs to come out

Choosing the keyhole approach makes a real difference to your recovery:

• Just three tiny cuts — in published series, lower rates of wound infection and incisional hernia than with the older open approach
• Less pain afterwards — most people manage well with regular paracetamol rather than strong opioid pain medication
• Shorter hospital stay — if your appendix has not burst, most people go home within 1–2 days
• Faster return to work and day-to-day activities — most people are managing light tasks within a week
• Allows the rest of the inside of your abdomen to be inspected during the operation, which is useful when the diagnosis is not entirely clear-cut
• No large scar in your lower right abdomen — just three small marks that fade considerably over the months ahead

It is natural to want to know what could go wrong — and you deserve an honest answer. The risks of this operation are small, and it is one of the most commonly performed procedures in Australian hospitals. Each of these will be discussed with you before your surgery, and you should feel free to ask about any of them.

• Wound infection — affects 2–5 in every 100 patients; in published series this rate is lower than with open surgery. It is treated with a short course of antibiotics
• Intra-abdominal abscess — a pocket of infection that forms inside the abdomen. In published series this happens in around 5 to 15 in every 100 cases where the appendix had already burst (perforated appendicitis), and is uncommon in non-perforated cases. It is usually treated with antibiotics alone, or with a small drain placed under ultrasound guidance — most people do not need another operation
• Ileus — where your bowel "goes quiet" and takes longer than usual to wake up after surgery. This affects 2–5% of patients and simply means a slightly longer stay in hospital while you wait for things to get moving again — you will be encouraged to walk and eat as soon as possible to help this along
• Conversion to open surgery — in published series this is needed in around 1 to 5 in every 100 planned keyhole operations (higher in perforated or complicated cases) to complete the operation safely. This is always a calm, considered decision made in your best interest — it is not a complication or a failure
• Injury to nearby structures — rarely, nearby bowel or blood vessels can be affected. Each step is carried out under direct vision to minimise this risk
• Stump appendicitis — rarely, a tiny remnant of appendix left at the base can become inflamed. This is an uncommon but recognised possibility

If you take blood thinners, diabetes medication, GLP-1 weight-loss injectables, or iron supplements, please flag this when you book — these need specific adjustments before the procedure. Full details are in the guide above.

• You will have blood tests to check for signs of infection and inflammation — a full blood count (FBC) measures your white cells, and a CRP (a protein that rises when there is inflammation in your body) helps confirm the diagnosis. If you are a woman of childbearing age, a beta-hCG test will also be done to rule out an ectopic pregnancy (a pregnancy in the wrong place), which can cause similar pain
• A CT scan or ultrasound of your abdomen will be done to confirm the diagnosis before any decision is made to operate
• Once appendicitis is confirmed, antibiotics will be given through a drip to start treating any infection before you go to theatre
• You will be asked to stop eating and drinking as soon as appendicitis is suspected — this is so the team can move quickly to theatre when needed and ensure you are safely fasted for the anaesthetic

Here is exactly what happens in the operating theatre, so there are no surprises:

• You will be admitted to Warringal Private Hospital or Epworth Eastern (or via the emergency department of your local hospital if the operation is urgent), and given a general anaesthetic — you will be completely asleep and positioned lying on your back
• Three small ports (thin hollow tubes, about the width of a pen) are placed through tiny skin cuts. Your abdomen is then gently inflated with harmless carbon dioxide gas, which creates a safe, open working space inside
• The appendix is located, its blood supply is divided, and the appendix itself is stapled at its base and removed — all through the keyhole instruments, without any large cut
• If your appendix had burst, the inside of your abdomen is thoroughly washed out with warm saline (salt water) to clear any infection that has leaked out — this is a careful and important step
• The appendix is sent to the laboratory for routine examination (called histology) — this is standard practice, and in most cases everything comes back exactly as expected
• You will recover on the surgical ward. If your appendix was perforated, you will continue to receive antibiotics through a drip for a day or two before switching to tablets to take home

Recovery from this operation is generally quicker than people expect. Here is a realistic picture of what the weeks ahead will look like:

• Days 1–2 in hospital: The nursing team will encourage you to get up and walk around as soon as you feel able — even a lap of the corridor makes a difference. You will start with clear fluids and gradually progress to a normal diet as your appetite and comfort allow
• Going home: Most people with straightforward appendicitis are ready to go home within 2–3 days. If your appendix had already burst (perforated appendicitis), expect to stay 3–5 days while the antibiotic drip does its job
• 1 week at home: Most people feel well enough to return to desk work, working from home, and gentle day-to-day activities. Avoid heavy lifting and strenuous exercise for 2–3 weeks to give your wounds time to heal properly
• Driving: You can drive again once you are off strong pain medication and can react quickly in an emergency — for most people that is around 5–7 days after surgery
• 3–4 weeks: You can return to full physical activity, including exercise, sport, and any manual work
• If your appendix was perforated, you will be sent home with a short course of antibiotic tablets to finish — please complete the full course even if you are feeling well
• Your laboratory results (histology from the appendix) will be reviewed at your follow-up appointment. In most cases everything is exactly as expected. Very occasionally an unexpected finding may come up and need further discussion — if that is the case, you will be contacted promptly with a clear explanation
• A post-operative review is routinely arranged 2–6 weeks after your surgery — this review is provided at no charge
• For day-by-day guidance on wound care, diet, shoulder-tip discomfort from the gas, and graded return to activity, see the Post-appendicectomy aftercare guide on the Resources page.

Post-operative concerns: Please call our rooms on (03) 9816 3951 and leave a message — this will be sent directly as a text to Mr Nguyen. Alternatively, you may text the office mobile on 0499 090 126. We aim to respond promptly during business hours.

Emergencies: For any life-threatening emergency, call 000 immediately or go to your nearest emergency department. Do not wait for a call back from our rooms. For the Austin Hospital Emergency Department: (03) 9496 5000.