Appendectomy in Children

An appendectomy is the surgical removal of the appendix. Appendectomy surgery in children is performed through either one small incision located in the right lower abdomen, or laparoscopically with a few tiny incisions (this is called a laparoscopic appendectomy). The surgical approach will be based on your child’s condition.

Appendectomy surgeries are typically completed laparoscopically (a minimally-invasive technique), through a few tiny incisions, as pictured.

In either case, your child will be placed under general anesthesia. All sutures placed during surgery are internal, dissolvable, and invisible from the outside. Incisions are covered and protected with waterproof surgical glue and possibly a small piece of tape or gauze.

Visit our Guide to Your Child's Surgery to learn more about what to expect on the day of your child’s surgery.

Non-perforated appendicitis means the appendix has not yet burst (or perforated). If this is the case for your child, antibiotics are typically stopped after the surgery to remove the appendix. Your child will be allowed to eat and drink when they feel ready.

Sometimes stronger pain medications may be needed at first, but most children are sent home on over-the-counter pain relievers only, such as acetaminophen or ibuprofen. Patients are usually able to go home the day after surgery. Some patients are even able to leave the same day.

With perforated appendicitis (the appendix has burst), treatment will depend on your child's infection. Some children require surgery right away, while others may require treatment with antibiotics first.

If your child has surgery right away for perforated appendicitis, they will remain on intravenous (IV) antibiotics to treat the infection following surgery. Depending on the extent of the infection, this treatment course can vary. Your child may spend several days to several weeks in the hospital. Children are gradually allowed to drink and eat as symptoms improve. However, many patients do not have an appetite and experience symptoms like fever, nausea, vomiting and diarrhea while recovering from the infection.

Once these symptoms have resolved, children are able to be discharged to home. Typically, antibiotics are not needed once they are discharged from the hospital.

If the surgeon caring for your child feels it is best, your child will be treated with antibiotics (usually for about two weeks) before the appendix is removed. This allows for the infection to be treated, the inflammation to resolve, and your child to heal. 

Patients may experience symptoms like fever, nausea, vomiting and diarrhea for days or even weeks before surgery. In this case, treatment requires them to stay in the hospital to receive IV fluids and hydration. Antibiotics are given intravenously (IV) in the hospital and can be given as a pill or liquid when symptoms like nausea and vomiting have resolved. When your child is able to take oral antibiotics without difficulty, no longer has a fever, and has resolution of symptoms, they can be discharged from the hospital to complete antibiotic therapy at home.

About four to six weeks after completing the antibiotic therapy, your child will have a follow-up appointment in the General Surgery Clinic to schedule surgery for removal of the appendix. Since the infection will be resolved at the time of the appendectomy, your child will usually require only one night in the hospital, and in some cases can even go home the same day.

Some patients with perforated appendicitis may develop an infected fluid pocket in the abdomen, called an abscess. Sometimes abscesses can be treated with antibiotics. However, in some instances, an abdominal drainage procedure may be required. This procedure is typically performed by a team of doctors called interventional radiologists.

Drainage procedures sometimes require a drain to be left in place for variable lengths of time. In most cases, your child will remain hospitalized until the drain is removed. The length of time the drain is kept in place depends on the amount of fluid present and drainage needed.

Your child’s recovery and follow-up care after an appendectomy will depend on your child’s condition, and if the appendix was perforated. The length of hospitalization will also vary. In order to be discharged from the hospital, your child needs to be able to walk, eat and drink without vomiting, be without fever, and have good pain control with the pain medicines prescribed.

Your child will be able to return to school when they feel comfortable and ready. This will be different for each child as well. Your child will not be able to participate in physical education or sports until they are cleared by your physician.

Some children will require a post-operative follow-up appointment a few weeks following discharge. However, many children can be assessed with a post-operative phone call to check in.

Please call us if your child has any of the following:

• Fever greater than 101.5 degrees F
• Vomiting or inability to tolerate any food or liquids
• Increasing or continuous abdominal pain
• Abdominal distention (swollen or enlarged)
• Drainage from incision(s)
• Redness or swelling of the incision(s)
• If you have any further questions or concerns

Appendicitis is considered an emergent condition, requiring immediate attention. If you think that your child may have appendicitis, please have them evaluated at the Emergency Department.