What is the appendix, where is it located in my body and what role does it have in my body?

Appendix is a hollow blind ending tubular organ attached to large intestine at a part known as caecum. Function of appendix is not very well known with some literature considering it as a vestigial organ. Some literature shows it to have some role in body’s immune system.

What is appendicitis?

When the appendix gets infected resulting in inflammation the condition is known as appendicitis.

How will I know that I have appendicitis?

Symptoms caused by appendicitis are variable.

Most common problem is a sudden onset pain which might be initially just at the centre of abdomen around umbilicus and as the pain progresses one might start feeling the pain on right lower abdomen. Although this is the typical presentation but the location and intensity of pain may vary as in different individuals the location of the tip of appendix is different.

You may have indigestion, bloating, vomiting, diarrhoea or constipation and you may not feel like eating anything.

You might run a low grade fever.

If you have any of these symptoms you should consult a doctor who would usually advice an ultrasound examination of the whole abdomen which picks up appendicitis.

Sometimes for further evaluation a CT scan is done.

I have never had any pain but found out on routine health check-up that I have gall bladder stones. What should I do?

It is true that very commonly gall bladder stones are not causing any problem and one finds out on routine ultrasound of the abdomen that one has gall bladder stones. In such a scenario one should opt for surgery even if there is no pain. Reason for this is that complications of gall bladder stones are debilitating and can range from severe pain to life threatening situations. It is impossible to predict when these complications might occur and when they do it adds to the treatment burden and prolongs the recovery.

What are the possible complications of gall bladder stones?

Stones may cause infection in gall bladder leading to acute cholecystitis (swollen inflamed gall bladder) where you may have severe pain just below your right rib cage (this is the commonest site of pain but pain can occur anywhere and sometimes goes to back).

Stone might slip from the gall bladder and get stuck in the main bile duct (known as common bile duct (CBD). This duct is the main channel for flow of bile from liver to our intestines, if a stone gets stuck here one may develop jaundice, severe pain, fever.

A stone stuck here can also hamper the flow of juices from pancreas and lead to acute pancreatitis which has possible life threatening consequences.

A stone may increases to a size which stops the outflow of juices from the gall bladder and this may lead to infection in the collected juices leading to pus formation in the gall bladder a condition known as empyema of gall bladder. This pus can rupture into the liver or into the abdominal cavity. This can be a life threatening complication.

An enlarging stone can erode into the intestine and form a false passage known as fistula.

A very rare complication is the possibility of gall bladder cancer.

If I have the gall bladder removed will it affect my digestion and do I need to be on lifelong dietary restrictions?

As the gall bladder does not produce anything and is just a storage organ its removal does not change the production of bile juices and hence no change in digestion.

There are no dietary restrictions due to removal of gall bladder but you will be advised to take frequent small meals and not to binge on fatty food. Both these advice should be followed by all even if they have their gall bladder.

How is the surgery performed for gall bladder removal?

The gold standard surgical method for removal of gall bladder is by laparoscopic method also known as minimal access/keyhole surgery where the entire process is done through four small punctures in the body. Two punctures are 1cm in size and two are 5mm.

In rare situations the surgery may be done by conventional open method where an incision is made just below the right rib cage for the procedure.

What are the preparations required before surgery and what should I expect during hospital stay and after discharge?

The preparation for surgery will be started from the outpatient department (OPD). You will be advised to undergo a few tests to assess your body functions and a pre-anaesthetic check-up (PAC) will be done by an anaesthesiologist (a specialist doctor) who will assess your fitness for anaesthesia.

Most likely you will be admitted on the day of surgery unless you have some specific concerns which warrant some extra stay before the surgery.

You will be advised not to eat or drink anything from midnight of the day prior to surgery and not to eat or drink anything on the morning of admission as well. If you take some medications regularly in the morning than please do not forget to discuss regarding them with your doctor so that he advices you on which medicine to take and which not to take.

Upon admission some paper work will be done and you will be asked to sign consent forms for anaesthesia and surgery.

You will be asked to change in to hospital clothing, shaving of the abdomen will be done and you will be given some intravenous medications.

Once the preparations are done you will be wheeled into the preoperative area where nursing staff and doctors will confirm your identity and then you will be shifted to the operating room. Your anaesthetist will put you under general anaesthesia and then surgery will start. Usually it takes about one hour for the surgery to be over and then you will be shifted to post-operative recovery area in conscious state. You will be kept there for couple of hours and then you will be shifted to your designated room.

Usually, with few exceptions, once around six hours are over after surgery and you feel comfortable you will be allowed some liquids and later some soft diet will be given.

You will be discharged to home the day after the surgery. You will be advised some medications on your discharge. You will be advised to take soft diet at home for two days and then gradually you can start having normal diet.

Usually if all goes well you will be called for a visit to OPD two days after discharge where the dressing over the stitches will be changed and then five days after discharge you will be called for removal of stitches.

How soon can I resume work after surgery? How much bed rest is advised? Is there any specific season of year when I should opt for surgery?

No bed rest is advised. You will be encouraged to walk about on your own from the next day of surgery. You can resume normal household work two days after surgery. Climbing stairs will not be a problem.

You may start driving one week after the surgery.

After a week you can resume walking. For a month you would be advised not to do weight training, running, jogging, cycling, yoga. You can resume all of this gradually after a month from the date of surgery.

Considering that almost all hospitals and households have air conditioning the season has become irrelevant so you can plan surgery as per the need and convenience anytime round the year.