The appendix is a tiny, worm-like structure that grows from the beginning of the colon. The appendix is generally considered to be a degenerative organ that has no physiological role in adults, so when the appendix becomes inflamed or infected (appendicitis) it needs to be surgically removed, also known as an appendectomy. Appendectomy is the most common surgical procedure, with an average of 1 in 2,000 people needing to have their appendix removed. So, what is appendicitis, how is the appendix removed, and what happens after it is removed? Signs and symptoms of appendicitis 1. abdominal pain 2. nausea, vomiting 3. fever 4. loss of appetite 5. constipation or diarrhea 6. weakness, depression 7. irritability (in pediatric patients) Examination and diagnosis Take a history and perform a physical examination to rank the cause of abdominal pain. In addition to appendicitis, a variety of causes of abdominal pain may be present, including gastritis, dyspepsia, constipation, diverticulitis, gallbladder disease, hernia, ulcers, reproductive disorders such as pelvic infections and torsion of ovarian cysts, cystitis, urinary stones, etc. The abdominal pain of appendicitis usually starts at the navel and eventually moves to the right lower abdomen, and may worsen with movement or quick release after pressure on the abdomen (rebound pain). Tests include a complete blood count (elevated white blood cells in case of infection), blood biochemistry, abdominal ultrasound or abdominal CT. abdominal X-rays or other tests may also be done to rule out other diseases. An electrocardiogram, chest X-ray and other tests may be used depending on the specific condition. Removal of the appendix Traditional appendectomy is performed by making a small incision in the right lower abdomen and removing the appendix after it has been disconnected from the beginning of the colon. General anesthesia or epidural anesthesia is usually required. Laparoscopic appendectomy, with several tiny incisions (about 1 cm) and a camera, is a technique suitable for early appendicitis with a rapid postoperative recovery. Laparoscopy may not be appropriate if there has been previous abdominal surgery or if the appendix has ruptured and perforated. Laparoscopy requires general anesthesia. Some patients can be treated without emergency surgery and with antibiotics while waiting. Certain patients may have delayed surgery. The surgeon’s decision is made on a case-by-case basis for each patient. How long does it take to recover from appendectomy? Patients can be discharged home the same day at the earliest after laparoscopic appendectomy, while open surgery usually takes at least a day or more before discharge. General activities can be resumed in a few days, and physical labor is avoided for 4-6 weeks. The vast majority of patients recover successfully after appendectomy, but a very small number of patients may develop the following complications or risks Those after appendectomy 1. Incisional infection: the most common. 2.Periappendiceal abscess: due to purulent inflammation, may occur. 3. Intestinal fistula: The appendectomy site cannot heal completely and feces flows into the abdominal cavity and penetrates the belly. It is generally rare, but the risk of occurrence is higher in malnourished, diabetic patients, especially those with Crohn’s disease. 4. Intestinal adhesions: Local adhesions are usually formed after surgery, which do not produce clinical symptoms. A small number of patients can lead to incomplete or complete intestinal obstruction, and very few eventually require surgical treatment. 5.Stump inflammation: The residual part of the appendix is too long and inflammation occurs again. 6.Incisional hernia: caused by incomplete healing of the surgical incision, weakness of the surgical incision site, and protrusion of the abdominal contents through the weak site to form a mass in the abdominal wall. 7, ulcerative colitis (UC) risk reduction: a meta-analysis summarizing 17 case-control studies found a negative association between appendectomy and the occurrence of ulcerative colitis, that is, the risk of ulcerative colitis decreased (by about 70%) after removal of the appendix. 8. Increased risk of Crohn’s disease (CD): As early as 2003, a follow-up study of a large number of cases (over 200,000 people) pointed out that the risk of Crohn’s disease increased by 47% after appendectomy, but the overall incidence was still very low. This risk exists after appendectomy and persists for up to 20 years, with a higher risk in women than in men. 9. Inflammatory bowel disease and appendectomy: Ulcerative colitis and Crohn’s are both inflammatory bowel diseases, but curiously, appendectomy reduces the risk of ulcerative colitis but increases the risk of Crohn’s disease. This opposite result may be related to the different immune mechanisms of the two diseases. Ulcerative colitis usually originates in the rectum (away from the appendix), whereas Crohn’s disease often involves the end of the ileum (near the appendix) and can involve the colon in 30-35% of patients. In addition, ulcerative colitis usually involves only the colonic mucosa, whereas Crohn’s disease can involve the mucosa down to the muscular layer of the intestinal wall. Other researchers suggest that there may be some antigen in the appendix that triggers the development of ulcerative colitis, or that the intestinal lesions of ulcerative colitis reduce the risk of appendicitis, and that animal studies have found a significant reduction in intestinal bacilli after removal of the appendix, and that these reasons lead to a negative association between ulcerative colitis and appendectomy. Crohn’s disease is shown on the left and ulcerative colitis on the right