Acute appendicitis affects about 10% of people during their lifetime, with no preferential age.

The appendix is usually found at the junction of the small intestine (“small intestine”) and the colon (“large intestine”). The function of the appendix is unknown, but more importantly, its removal has no impact on your health.

Acute appendicitis corresponds to an infection of the appendix which can, if the evolution is too prolonged, become complicated in the form:

• an appendicular abscess,
• more or less generalized peritonitis.

The removal of the appendix is called an appendectomy. This procedure is indicated when you have pain, fever, disturbances in the results of your blood tests and abnormalities on your imaging examinations (ultrasound or scanner) which make us suspect an infection of your appendix.

The intervention consists of removing the infected appendix. For this, your surgeon must cut the base of the appendix.

We have 2 techniques:

• Either by a classic and old technique by an incision opposite the appendix of about 3 to 5 cm.
• Either a more recent and more modern technique by laparoscopy (3 incisions of one centimeter each) which has the advantage of being very non-aggressive, reduces post-operative pain and allows a rapid resumption of daily activities.

Given these elements, we most often carry out the surgical treatment of appendicitis by laparoscopic route.

After having met your surgeon, who confirmed that your appendix had to be removed, you will meet your anesthesiologist who will make sure of the general anesthesia modalities. If you take medication on a daily basis you should discuss this with your surgeon and anesthetist, they may want you to take some of your medications before the procedure with a water background. If you take aspirin or medication to thin your blood, discuss this with your surgeon and anesthesiologist.

The Charcot clinic team (Lyon) welcomes you on admission, checks the administrative formalities, ensures that there is no new information and that the instructions given are followed.
Then you are taken to the operating room in the operating room, your surgeon and your anesthetist surrounded by their team welcome you and carry out the usual checks (identity, compliance with instructions, shower, fasting, etc.).

Appendectomy surgery is most often performed laparoscopically.

When you are asleep, your surgeon, assisted by a nurse, a camera and instruments passing through trocars, will check the appendix artery and the appendix in order to disconnect it from the colon. The appendix is exteriorized through one of the trocar ports.

The duration of the procedure varies from 15 to 60 minutes and depends on the difficulty that your surgeon may encounter depending on the condition of your appendix, the spread and the extent of the infection in the abdominal cavity. Depending on the severity of the infection, antibiotics may also be given. A drain can sometimes be left in place, you will then be hospitalized for a few days.

Once awake, after a few hours in the recovery room, you return to your room. A nurse on the ward makes sure that you are not in too much pain, that you are not nauseous or vomiting, that you gradually come to your senses. Your surgeon comes by at the end of the day to make sure that you are well, authorizes food, explains to you what he observed during the intervention and gives you post-operative instructions.

This operation is common practice, its technique is precise, but as in any intervention, certain complications can occur:

• a reaction to anesthesia
• bleeding,
• a wound of an abdominal organ, especially when surgical dissection is difficult in case of peritonitis or surgical history in particular.

Local changes discovered during the operation or the appearance of an unexpected complication may lead your surgeon to modify the operation initially planned in order to do everything possible to remedy the difficulties encountered. The laparoscopic approach can therefore be converted into a laparotomy (conventional surgery via a scar in the right iliac fossa or under the navel).

The list of complications described is not exhaustive, but it is important to understand that one of the objectives of the preoperative consultation is to allow your surgeon to weigh up the risks that you would take by not having surgery with the risks inherent in an intervention. If an indication for surgery has been selected, unlike cosmetic surgery, it is very likely that there would be more risks in not carrying out this intervention.

If in doubt on your part, do not hesitate to ask your surgeon for clarification.

Usually, this intervention is not very painful and the pain responds well to simple analgesics (paracetamol) which will also be prescribed to you when you leave the hospital.

The duration of hospitalization is usually a few days (sometimes 24 hours), it depends on the degree of infection. You may be prescribed antibiotics.

You will be able to eat and drink the day after the operation (sometimes in the evening).

There is no special diet to follow after removal of the appendix.

You can gradually resume your daily activities and light activity.

A work stoppage of 2 to 4 weeks will be prescribed for you (taking into account the particularities of your work). There is no need for a convalescent home except in special cases.

Pain under the ribs, towards the shoulders may appear the day after the operation. They are due to laparoscopic gas. These pains always disappear in 24-48 hours.

One month after the operation, you go to your post-operative consultation. Your surgeon will then authorize you to resume your physical and sporting activities.

You must absolutely contact your surgeon in case of:

• persistent fever,
• abdominal pain that resists the medication prescribed after the procedure,
• persistent nausea or vomiting,
• or if oozing occurs through an incision.

When you leave, the documents provided by your surgeon and/or the nurses in the service include the telephone number of the surgery secretariat and the telephone number of the general practitioner on duty practicing at the Charcot clinic (Lyon). He can, if necessary, hospitalize you. Do not hesitate to contact us.

Resume very light activity, walking is allowed, avoid driving for 5 days. It is normal for the surgical area to be painful at first and will remain sensitive for some time. This should not prevent you from moving, walking and carrying out the acts of daily life. Pain in the shoulders, under the ribs, are also possible, they are related to the gas necessary for the laparoscopy and must disappear in 2 to 3 days.

1. Precautions

• It is advisable to take showers (the bath is to be avoided for a month).
• Do not carry heavy loads (for at least one month).
• On prescription from your anesthesiologist: wearing compression stockings (for the entire duration of the anticoagulant treatment) and anticoagulant.
• In case of exposure to the sun, provide protection against UV (total sunscreen cream) the best solution is to wear clean clothing to cover the scar.
• Avoid practicing sport until the next consultation.

2. Bandages

• You have to leave the scars exposed. There is no need to bring in a nurse.
• The threads on your scar are absorbable, they can get wet and will disappear on their own. After your shower, pat the scars dry with a clean towel.

3. Diet

Food can be resumed without restriction, but in moderation. It is advisable not to be constipated for that eat fibers: green vegetables, fruits etc…