Appendicitis is treated primarily with surgery to remove the appendix, a procedure called an appendectomy. In uncomplicated cases, the operation takes roughly 45 to 55 minutes and carries a very low risk of serious complications. For select patients with early, uncomplicated appendicitis, antibiotics alone can resolve the infection without surgery, though about 39% of those patients experience a recurrence within five years.
Laparoscopic vs. Open Surgery
Most appendectomies today are performed laparoscopically. The surgeon makes three small incisions in the abdomen, inflates the abdominal cavity with gas for visibility, and removes the appendix through one of the ports using a specimen bag to prevent spillage. The average operating time is about 47 minutes.
Open surgery uses a single larger incision in the lower abdomen. It tends to take slightly longer, averaging around 53 minutes. Surgeons may choose the open approach when the appendix has already ruptured and there’s significant contamination inside the abdomen, or when scar tissue from prior surgeries makes laparoscopic access difficult. In open procedures for perforated appendicitis, the skin incision is sometimes left open initially to reduce the risk of wound infection, then closed a few days later.
Both approaches accomplish the same thing: complete removal of the appendix. Laparoscopic surgery generally means less post-operative pain, smaller scars, and a faster return to normal activities. Your surgeon will recommend the approach that fits your situation.
What Happens Before Surgery
Once appendicitis is diagnosed, the surgical team moves quickly. You’ll receive intravenous antibiotics within 60 minutes before the incision to reduce the risk of surgical infection. You’ll also be given fluids through an IV, since most people with appendicitis arrive dehydrated and haven’t been able to eat or drink comfortably. Pain medication is started right away. The goal is to get you into the operating room as soon as the team is assembled, typically within hours of diagnosis.
Treating Appendicitis With Antibiotics Alone
For uncomplicated appendicitis, where imaging confirms the appendix hasn’t ruptured and there’s no sign of a hardened deposit (called a fecalith) blocking it, antibiotics without surgery are a real option. You’d be admitted to the hospital, started on IV antibiotics, and monitored. If your pain improves over 12 to 24 hours, you transition to oral antibiotics and go home to finish a course lasting about 10 days total.
The catch is recurrence. The landmark APPAC trial followed patients for five years after successful antibiotic treatment and found that 39.1% eventually had their appendicitis come back. Most recurrences happened in the first year, when about 27% of patients ended up needing surgery anyway. After that first year, the rate slowed considerably: only about 16% of the remaining patients needed an appendectomy over the next four years. So if you make it through the first year without a flare, your odds of avoiding surgery long-term improve significantly.
Antibiotic Treatment in Children
Nonoperative management is also being used in children, though with stricter eligibility criteria. Current protocols typically limit the approach to children ages 7 to 17 who have had abdominal pain for 48 hours or less, whose white blood cell count is below a certain threshold, and whose imaging shows a mildly enlarged appendix with no signs of rupture, abscess, or fecalith. Children with a fecalith have an unacceptably high failure rate with antibiotics alone and are directed to surgery.
The treatment follows the same general pattern as in adults: IV antibiotics in the hospital, close monitoring, and a switch to oral antibiotics if the child improves. If pain worsens at any point, the team proceeds with laparoscopic appendectomy without delay.
When the Appendix Has Already Ruptured
A perforated appendix is a more serious situation. The complication rate in these patients is roughly 72%, and the mortality rate is about 4.8%. Those numbers climb steeply in older adults with other health conditions and delayed presentations. Large amounts of fluid contamination inside the abdomen are associated with significantly worse outcomes.
Treatment depends on how stable you are and how contained the infection is. For stable patients, both immediate surgery and nonoperative management (IV antibiotics, possible drainage of any abscess) are considered safe. If an abscess has formed and it’s large enough, a radiologist can place a drain through the skin to help clear the infection before any surgery. Smaller abscesses, under about 5 centimeters, are more likely to fail this conservative approach and may need earlier surgical intervention.
Adults over 40 who are treated for perforated appendicitis typically undergo a follow-up colonoscopy. This is because a small but meaningful percentage of these cases turn out to involve an underlying growth in the appendix or nearby tissue that needs to be identified.
Recovery After Appendectomy
After laparoscopic surgery, most people go home within one to two days. You’ll feel sore around the incision sites and may have some shoulder pain from the gas used during the procedure, which resolves within a day or two. The key restriction is lifting: nothing over 10 pounds (about 4.5 kilograms) for two weeks. That means no picking up toddlers, grocery bags, or gym weights during that window.
Open surgery requires a longer recovery. The lifting restriction extends to four to six weeks, and hospital stays are typically longer, especially if the appendix was perforated. When you can return to work depends on what you do. A desk job might be manageable within a week or two after laparoscopic surgery. Physically demanding work takes longer, and your surgeon will clear you based on how you’re healing.
Perforated cases have the longest recovery. If the skin was left open to prevent wound infection, you’ll need wound care at home, often with packing changes, until the incision closes on its own over several weeks. Extended courses of antibiotics after discharge are common when there was significant contamination.