Pediatric Appendectomy

(Removal of a Child's Appendix)

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.

The appendectomy may be done as an open surgery, which involves cutting into the abdomen and directly removing the organ. Or it may be done through one or several smaller incisions (cuts) using a camera and small instruments. This is called a laparoscopic surgery.

Reasons for the procedure

The function of the appendix is still not fully clear to medical experts, but it doesn’t appear to be an essential organ. What is known is that it produces proteins called immunoglobulins, which help fight infection in the body. Sometimes the appendix becomes blocked. Mucus trapped inside can allow bacteria to thrive. The resulting infection and inflammation is called appendicitis. This illness is especially 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 occurs, infection can spread throughout the abdomen and 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 that's used to put your child to sleep. These include breathing problems and reactions to the anesthesia drugs.

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 health care 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 doctor when your child should stop eating and drinking beforehand.

Before the procedure begins, the health care team may give your child an injection of medication to relax him or her. They will also put an intravenous (IV) needle into a vein to allow them to later give medicine to put your child to sleep.

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 in length. 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 incision in the skin.

During a laparoscopic procedure, the surgeon will make one or several 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 shut the opening in the intestine and any incisions in the skin. Laparoscopic surgery using one small cut is called single-incision laparoscopic surgery (SILS).

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

On occasion, 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 during a follow-up visit. Follow the health care provider’s directions on bathing and taking care of the incision.

When to seek medical care

Contact your child's doctor if you notice symptoms including:

  • A fever higher than 101°F (38.3°C)

  • Vomiting

  • Redness or swelling around the incision

  • Sluggishness

  • Green or yellow drainage from any incision

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

  • Abdominal swelling