Appendectomy is performed for acute appendicitis (simple, suppurative, gangrenous, gangrenous with perforation); chronic or recurrent appendicitis; as an interval procedure after recovery from an appendiceal abscess; for small (less than 2.5 cm) carcinoid tumors or benign mucoceles; and prophylactically during laparotomy for other conditions. The accuracy of diagnosis in acute appendicitis has increased to over 90% in several recent series using diagnostic adjuncts such as graded-compression ultrasound and special CT protocols. In addition, percutaneous drainage of periappendiceal abscesses may allow for a subsequent single operation to remove the remnant of the perforated appendix (interval appendectomy).

With the patient under general anesthesia, appendectomy may be performed through a right lower quadrant muscle-splitting incision or by a laparoscopic approach using three ports. With simple, suppurative, or gangrenous appendicitis, the stress of operation is minimal. For patients with perforated gangrenous appendicitis and diffuse peritonitis or with a large intraabdominal abscess, stress can be moderate or major. The duration of a simple appendectomy is 45 minutes, but this increases to 60 to 75 minutes in obese patients with retrocecal appendicitis and rupture. In some of these patients, the usual 6- to 7-cm incision must be extended to gain exposure of the posterior cecum and ascending colon. Blood transfusion is never required.

Usual postoperative course

Expected postoperative hospital stay

1 to 2 days for simple, suppurative, or gangrenous (without rupture) appendicitis; 7 to 10 days for perforated appendicitis with diffuse peritonitis or an intra-abdominal abscess.