Pediatric Appendectomy

Procedure overview

A pediatric appendectomy is a surgery to remove a child’s appendix. The appendix is a small pouch that’s attached to the large intestine on the lower right side of the abdomen.

An appendectomy may be done as an open surgery. This involves cutting into the abdomen and removing the appendix. Or it may be done through one or several smaller cuts using a camera and small instruments. This is called a laparoscopic surgery.

Reasons for the procedure

The job of the appendix is still not fully understood. However, it doesn’t seem to be a vital organ. What is known is that it makes proteins called immunoglobulins. These help fight infection in the body. Sometimes the appendix becomes blocked. Mucus trapped inside can allow bacteria to thrive. This leads to infection and inflammation, which is called appendicitis. This illness is very common in children, teens, and young adults. A young person with this problem may need an appendectomy.

An appendix that is inflamed can burst if it is not removed. If this happens, infection can spread throughout the abdomen. This can cause peritonitis, a potentially dangerous condition.

Risks of the procedure

As with other surgeries, the possible risks of this procedure include:

  • Bleeding

  • Infection

  • Problems from the anesthesia

In addition, other possible risks include:

  • Leakage from the large intestine where the appendix was removed

  • The need for a longer hospital stay and medicines, such as antibiotics, if the appendix has ruptured before the surgery

  • Injuries to nearby organs during the surgery

There may be other risks, depending on your child’s specific medical condition. Be sure to discuss any concerns with your child’s doctor before the procedure.

Before the procedure

This is usually an emergency surgery, so your child may not have a lot of time to prepare for it. The healthcare team will want to know when your child last ate. That's because having food in the stomach can cause problems when your child is under anesthesia. If the surgery is planned ahead of time, ask the healthcare provider when your child should stop eating and drinking beforehand.

Before the procedure begins, your child may be given an injection of medicine to help relax. Your child will also have an IV placed into a vein to allow for other medicines to be given. This is how your child will be put to sleep for the surgery.

During the procedure

During an open procedure, the surgeon will make a cut into the skin and the fat underneath. The cut will be one to two inches long. Upon reaching the appendix, the surgeon will cut it loose and remove it. The surgeon will then close the opening in the intestine and the cut in the skin.

During a laparoscopic procedure, the surgeon will make a few small cuts in the abdomen. A tiny camera will be placed inside through one cut so the surgeon can see the procedure on a video screen. Air will be put into the abdomen through a tube to allow the surgeon to see better. The surgeon will then remove the appendix using small instruments. When finished, the surgeon will stitch up the opening in the intestine and any cuts in the skin. Laparoscopic surgery using one small cut is called single-incision laparoscopic surgery.

If your child’s appendix has burst, a drainage tube may be left in the abdomen to drain away fluid.

Sometimes, the surgeon may plan a laparoscopic surgery, but need to switch to an open surgery because it seems like a safer option.

After the procedure

After the surgery, your child will go to a recovery room before being transferred to a regular room. Your child will receive pain medicine through the IV, then later by mouth.

Your child will be encouraged to get up and move around later that day or the next day. After laparoscopic surgery, your child may feel cramps or shoulder pain from the air that was put into the abdomen. Children usually go home a day or two after the surgery. If the appendix ruptured before the surgery, your child may need to stay in the hospital for up to a week. In these cases, your child may need IV antibiotics for a week or more.

Children will usually need to avoid physical activities until the surgeon says it’s OK. This will usually be at a follow-up visit. Follow the healthcare provider’s directions on bathing and taking care of the incision.

When to seek medical care

Contact your child’s healthcare provider if you notice symptoms including:

  • A fever higher than 101°F(38.3°C)

  • Abdominal swelling

  • Green or yellow drainage from any incision

  • Pain that increases, rather than decreases, as hours or days pass

  • Redness or swelling around the incision

  • Sluggishness

  • Vomiting

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