Appendicectomy: removing the appendix, what to expect

The appendix is a small tube attached to the large bowel. When it becomes inflamed and infected, usually with pain that starts around the navel and moves to the lower right of the abdomen, there is a risk that it will burst and spread infection through the abdomen. Taking it out removes that risk and, in most people, ends the problem for good.

The NHS states that appendicitis is usually treated with surgery. Because the decision is made in the emergency setting, the usual route is through A&E or a surgical assessment unit after a GP or NHS 111 contact, followed by examination, blood tests and sometimes a scan.

The NHS says that in select cases appendicitis can be treated with antibiotics rather than surgery, such as when the infection has not spread and the operation would be high risk for the person. It also describes an appendix mass, where the body has walled off the inflamed appendix: this may be treated with antibiotics first, with surgery weeks later if symptoms persist.

Antibiotics alone are a decision for the surgical team, not a choice to make at home, and the appendicitis can recur afterwards. If you are offered this route, ask what the plan is if the pain returns.

Because appendicectomy is usually done urgently, preparation is brief. You will be asked to stop eating and drinking, and you will usually be given fluids and antibiotics through a drip and pain relief. Tell the team about medicines you take, allergies, and if you could be pregnant.

If you have time to pack, bring a phone charger, comfortable clothes and a list of your medicines. A relative or friend can bring other items later.

A St George's trust leaflet states that the operation is performed under general anaesthetic and may be done either by keyhole or open surgery. In keyhole surgery, the NHS explains, a thin tube with a camera is used to see the appendix through small cuts in the abdomen, and the appendix is removed through one of them. If the appendix is badly inflamed, or has already burst, the surgeon may use a larger cut in the lower right abdomen.

The NHS gives about an hour as the typical operating time. A surgeon who starts keyhole may switch to open surgery if the view is poor or the infection is extensive; this is part of the consent discussion rather than a failure.

The NHS lists wound infection, bleeding, scar tissue forming inside the abdomen, abscess development and, rarely, appendicitis recurring in a remaining stump of the appendix. The St George's leaflet adds blood clots and anaesthetic complications, and describes serious complications as rare.

The risk of problems rises when the appendix has burst before surgery, because infection may have spread. The pages used here did not give reliable percentages, so none are quoted. Your surgeon can explain how your own findings affect risk.

The NHS says keyhole patients may leave hospital the day after surgery, whereas open surgery typically means several days; the St George's leaflet says most keyhole patients go home the same or next day. For recovery, the NHS gives 1 to 2 weeks for most people, while the leaflet suggests 2 to 4 weeks after keyhole and 4 to 6 after open surgery. The leaflet advises no driving for at least 1 week after keyhole surgery, a desk job after 1 to 2 weeks and strenuous activity avoided for 4 to 6 weeks.

These are ranges, and individual recovery varies. The linked timeline page sets out the stages.

Contact NHS 111 or the ward if your abdominal pain worsens or returns, or if you notice wound discharge, swelling, increasing redness or a fever. The NHS advises 999 or A&E for severe pain, confusion, discoloured skin or difficulty breathing, which can signal a serious infection or clot.

Because appendicitis is an emergency, treatment is normally through the NHS emergency pathway regardless of insurance. Private care becomes a factor only if you are already an insured patient admitted to a private hospital with an emergency department, so check what your policy covers beforehand.

• Is keyhole surgery suitable for me, or is open surgery more likely?

• Was my appendix burst, and does that change my antibiotics or recovery?

• Which activity limits apply to my job?

• Will anyone follow me up after discharge?