Appendicectomy — the surgical removal of the appendix — is one of the most commonly performed emergency surgical procedures in Australia. It is the standard and definitive treatment for acute appendicitis, and when performed promptly by an experienced surgeon, it is a safe procedure with an excellent recovery and outcome.

At Breast & Surgical Oncology at The Poche Centre, appendicectomy is performed by our specialist general surgeons with extensive experience in laparoscopic abdominal surgery.

The Appendix and Appendicitis

The appendix is a small, finger-shaped pouch of tissue attached to the large intestine in the lower right abdomen. It has no clearly defined essential function in adults. Appendicitis occurs when the appendix becomes inflamed, most commonly due to a blockage of the appendix lumen by hardened stool, mucus, or, less commonly, infection. Once blocked, bacteria multiply rapidly within the appendix, causing progressive inflammation, swelling, and — if untreated — perforation (rupture) of the appendix wall.

Appendicitis can occur at any age but is most common in children, teenagers, and young adults. It is a true surgical emergency — a perforated appendix leads to peritonitis (widespread abdominal infection) and significantly increases the complexity and risk of surgery.

Symptoms of Appendicitis

The classic presentation of appendicitis begins with central abdominal pain that migrates over several hours to the lower right abdomen (the right iliac fossa), becoming increasingly localised, constant, and severe. Associated symptoms include nausea, vomiting, loss of appetite, and fever. The abdomen becomes tender to touch in the right lower quadrant, often with rebound tenderness (pain that is worse on releasing pressure than on pressing).

Not all cases of appendicitis present classically. The pain may remain central, be less severe, or be located differently depending on the position of the appendix. In pregnant women, the appendix sits higher in the abdomen and pain may be felt in the right upper quadrant. In elderly patients, symptoms may be more subtle and the risk of perforation at presentation is higher.

If you or someone you are with develops progressively worsening abdominal pain with fever and nausea, seek emergency medical assessment without delay.

Diagnosis

Appendicitis is primarily a clinical diagnosis supported by blood tests and imaging. An elevated white cell count and CRP on blood testing indicate active inflammation. Ultrasound is a useful first-line imaging tool, particularly in children and pregnant women, as it avoids radiation exposure. CT scan of the abdomen and pelvis is the most sensitive and specific imaging investigation for appendicitis in adults and is widely used when the diagnosis is uncertain on clinical grounds or ultrasound alone. MRI may be used as an alternative to CT in pregnant patients.

In straightforward cases with a classic clinical presentation, imaging may not be required before proceeding to surgery.

Treatment — Laparoscopic Appendicectomy

Laparoscopic (keyhole) appendicectomy is the preferred surgical approach for acute appendicitis in most patients, and is the standard of care at our practice. It is performed under general anaesthetic using three small incisions — typically 5 to 10 mm each — through which a laparoscope and fine surgical instruments are inserted. The appendix is identified, its blood supply is divided, and the appendix is stapled or tied at its base and removed through one of the port incisions.

The laparoscopic approach is associated with significantly less post-operative pain, a faster return to normal activity, lower wound infection rates, and better cosmetic outcomes compared to open surgery. It also allows thorough inspection of the entire abdominal cavity, which is valuable when the diagnosis is uncertain and alternative pathology may be present.

Open appendicectomy — performed through a larger incision in the right lower abdomen — is used when laparoscopic surgery is not safe or feasible, including in cases of severe perforation with widespread contamination, dense adhesions from previous surgery, or when laparoscopic conversion is required during the operation.

Complicated Appendicitis

When the appendix has perforated before surgery, management is more complex. A perforated appendix with localised abscess formation may be managed initially with antibiotics and, if a collection is present, ultrasound or CT-guided drainage, with interval appendicectomy planned after the acute inflammation has settled. When perforation has caused widespread peritonitis, emergency surgery is required without delay. Laparoscopic washout and appendicectomy is performed to remove the appendix and thoroughly irrigate the abdominal cavity.

Antibiotics as an Alternative to Surgery

For uncomplicated acute appendicitis without perforation or abscess, antibiotic treatment alone — without surgery — has been shown in clinical trials to be effective in resolving the acute episode in a meaningful proportion of patients. However, approximately 20 to 40% of patients treated with antibiotics alone will have recurrent appendicitis within five years and ultimately require appendicectomy. Non-operative management may be appropriate for selected patients who wish to avoid surgery or who have significant comorbidities, and the risks and benefits are discussed at the time of presentation.

Recovery

Recovery from uncomplicated laparoscopic appendicectomy is rapid. Most patients are discharged within one to two days of surgery. Pain is generally well managed with regular oral analgesia and settles quickly over the first week. Most patients can return to light activities and desk work within one to two weeks and to full physical activity within three to four weeks.

For complicated appendicitis with perforation, recovery is longer and more variable depending on the degree of contamination, the need for washout, and the patient's overall health. Hospital stay may be three to seven days and return to full activity may take four to six weeks or longer.

Wounds are closed with dissolving sutures. The small port site scars from laparoscopic appendicectomy fade well over six to twelve months.

Risks and Complications

Laparoscopic appendicectomy is a safe and commonly performed procedure. Risks include wound infection (less common with the laparoscopic approach than open surgery), intra-abdominal abscess (more common after complicated perforated appendicitis), bleeding, injury to adjacent structures, adhesion formation, and anaesthetic risks. Conversion to open surgery occurs in a small proportion of laparoscopic cases and will be discussed as a possibility before the operation.

All risks are discussed in detail at the pre-operative assessment.

Booking an Appointment

Acute appendicitis is a surgical emergency managed through the hospital emergency department rather than by outpatient referral. If you have symptoms suggestive of appendicitis, please attend your nearest emergency department or call 000.

For elective surgical consultation — including interval appendicectomy after non-operative management of appendicitis, or assessment of recurrent right lower abdominal pain — a GP referral to our practice is appropriate.

This page is intended as a general guide only and does not replace personalised medical advice. If you have symptoms of appendicitis, please seek emergency medical assessment immediately.