Different Treatments for Acute Appendicitis

No one likes to find out that they have appendicitis — or that they need emergency surgery. It can be even more stressful if you don’t know what comes next or what to expect. And it can be hard to get the answers you need when you get a diagnosis in the ER or your providers are busy. 

Most people with appendicitis will need treatment that combines surgery and antibiotics. But depending on your specific case, there can be some variation in the treatment plan. Let’s walk through some of the possibilities, so you have an idea of what to expect for your treatment and recovery. 

Quiz: Do I have appendicitis?

Do you need surgery for appendicitis? 

Most people with appendicitis will need surgery to remove their appendix (called an “appendectomy”). This is the most definitive way to prevent the infection from getting worse and to prevent future complications. But there’s still some variation in approaches to treatment, which we’ll explain below.

Open laparotomy

The traditional way that surgeons remove the appendix is via an open laparotomy. In this procedure, the surgeon will make an incision in the lower part of your abdomen and remove the appendix. The advantage to this technique is that the surgeon can get a clear view of the appendix and the surrounding area. That way they can make sure they clear out the whole infection. 

Laparoscopic appendectomy

This procedure is a little more modern — it uses a small camera to help remove the appendix in a way that is less invasive than an open surgery. For that reason, it’s now the preferred and most common surgical approach when possible. 

In this technique, surgeons usually make three small incisions. The first incision allows air to inflate the abdominal cavity, which makes room for the surgeon to work. The second incision is for the camera, so that the surgeon can see inside the abdomen. The last incision is for the instruments needed to remove the appendix. Because the incisions are smaller, the recovery time from this surgery is usually quicker. 

But this approach isn’t always the best option — like when the appendix is significantly inflamed or ruptured (burst open). Sometimes the surgeon will know this before the surgery and will recommend an open laparotomy instead. Other times, the extent of the infection won’t be clear until they start the surgery and the surgeon can directly see the appendix. In these cases, the surgeon may need to change from a laparoscopic to open appendectomy in the middle of the procedure. 

Delayed appendectomy

If your appendix has burst, your provider may suggest an intentional delay in your surgery. This is so they can give you antibiotics to decrease the amount of infection in your abdomen. If there’s an abscess (an area of infection that’s walled off), they may first drain the infection with a small needle they insert through the skin. Once the infection in your abdomen is under control — usually in 1 to 2 days — it will be easier and safer to remove your appendix.

Nonoperative management

Some newer research suggests that not everyone with appendicitis needs surgical treatment. This might be an option for someone with a particularly mild case, or someone who cannot have surgery for some reason. In these instances, the healthcare team treats the person with antibiotics and monitors to see if their symptoms improve. But this approach isn’t ideal, given the risk for worsening infection or another appendicitis after recovery from the first one. 

What are the risks of surgery?

Any surgical procedure comes with risks. Prior to the procedure, your provider will take time to review these with you and make sure to answer all of your questions. But it helps to have some information before that discussion, so you can think through some of the questions you would like to ask. Here are some of the risks they will discuss with you:

• Anesthesia: Your provider will give you medications to put you to sleep during the surgery. And these medications can cause an adverse reaction or affect things like your breathing, heart rate, and blood pressure. Rest assured that you will have an anesthesia team that will take care of you throughout the surgery. They will monitor the machines that help you breathe and give you medications you may need.

• Pain: An appendectomy is a big operation. Not only is the appendicitis itself painful, but the surgery can cause discomfort and soreness. You will likely have some pain afterward as your body heals.  

• Infection: Because surgery removes an appendix that has an infection, even with your surgical team’s best care, there can be an infection or abscess after the surgery. Antibiotics can often treat this, but in rare circumstances you may need an additional procedure to drain or clean out the infection.

• Bleeding: There’s always the possibility of bleeding during or after your surgery. This may be minor, like some bruising. Or it could be more serious, like internal bleeding. But even in more severe cases, the bleeding will likely stop on its own. A blood transfusion can also treat it, in the case of significant blood loss.

• Injury to other organs: One of the more rare complications is an injury to your bowel or other organs in your abdomen. This can happen with any surgery in which there are surgical instruments inside the abdomen. The good news is that because the surgeon only needs to work in one corner of the abdomen, this is less likely to happen in an appendectomy.

What medications do you use for appendicitis?

The main medication for appendicitis treatment is antibiotics. Providers often start antibiotics as soon as they make a diagnosis, while you await surgery. In many cases, they’ll stop the antibiotics after they remove the infection in surgery. But some people need to have a few more doses after surgery to make sure their infection is fully treated.

Treatment often includes pain medication as well. Appendicitis hurts. So whether or not you have surgery, your provider will likely give you medications for pain. But the pain typically improves significantly once the surgeon removes the appendix. In most cases, acetaminophen (Tylenol) or NSAIDs (nonsteroidal anti-inflammatory drugs) can effectively treat any soreness left over from the surgery. 

What happens if you don’t treat appendicitis?

Surgery, especially when you haven’t planned on it, can sound scary. But the risks of an untreated appendix are even greater. 

When you don’t treat appendicitis, it can burst or rupture. When this happens, your appendix can no longer contain the infection, and the infection can spread to other parts of the abdomen. This is a very serious condition, which may need prolonged courses of antibiotics, multiple surgical procedures, and potentially a stay in the intensive care unit. But you can avoid these complications with timely and appropriate treatment. 

Recovery after surgery

Since most cases of appendicitis require surgery, we’ll review the two main stages of recovery after your appendectomy. That way you’ll know what to expect in the hospital and at home.

In the hospital

Recovery in the hospital can vary depending on the type of surgery you have. For a laparoscopic surgery, you may be able to go home the same day. If you have an open laparotomy, you may stay 2 or 3 days. Here are some of the factors that you and your providers will take into account when deciding when you can go home: 

• Managing pain: An appendectomy is a big procedure, and it’s OK if you need pain medication. Your provider will want to be sure your pain is well controlled before you head home. 

• Moving around: Most people are able to get out of bed around 24 hours after their surgery. You may need some help at first. But recovery tends to improve more rapidly when you are able to start moving about.

• Eating: Your bowels have been through a lot! Eating may be a little tough at first. But your provider will make sure you can at least keep down liquids before you head home. 

Once you start to feel better, you will be able to go home so you can fully recover in a comfortable environment.

At home

Be patient with yourself. Your body has been through a lot. It may take 2 to 4 weeks for you to get back to all of your normal activities. Recovery is different for each person. Here are some things to keep in mind as your body heals:

• Rest: You may find that you tire more easily and need to rest more often. That can be hard if you’re used to having more energy or have busy days. Be patient with your body.

• Eat: Most people notice a slow and steady return of their appetite. But it may take a little time to feel like your food intake has returned to normal. Even if you’re eating small amounts, every bit of nutrition makes a difference. Your body is working hard for you, and it needs food to heal. 

• Bowel movements: Both the anesthesia and surgery can be rough on your intestines. It may take some time for them to wake up and start functioning normally. Walking and moving around can be a big help. Sometimes you may need a little help with a laxative to get you back to normal. Your provider can give you recommendations on which ones are best for you.

• Activity restrictions: It’s very likely you will have some activity restrictions to allow your wounds to heal well. This may mean that for a short period of time you will be restricted from doing things that could put pressure on your incisions — like lifting anything heavy or even driving. Typically your team will clear these restrictions during your postoperative visit.

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Written by:

Jill L. Jaimes, MD

Jill L. Jaimes, MD, is a board-certified pediatric emergency medicine physician with over 20 years of clinical experience. She received her medical degree from Baylor College of Medicine and completed her residency and fellowship training at Texas Children’s Hospital.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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