Appendectomy

What Is Appendicitis?

Your side may hurt so much that you called your doctor. Or maybe you went straight to the hospital emergency room. If the symptoms came on quickly, you may have appendicitis. This is an infection of the appendix. Surgery can stop the infection and relieve your symptoms. Read on to learn more.

Your Appendix

The appendix is a hollow structure about the size of your little finger. It opens off the colon (large bowel). The purpose of the appendix is unclear. But if it is blocked, it may become infected.

A normal appendix

An inflamed appendix

Pain and Other Symptoms

Symptoms tend to appear quickly, often over a day or two. Symptoms can include:

Pain that starts in the center of your belly and moves to your lower right side
Increased pain and pressure on your side when you walk
Vomiting, nausea, or decreased appetite
Fever or fatigue
Diarrhea or constipation

How Surgery Helps

Medication can�t cure appendicitis. But an appendectomy (surgery to remove an infected appendix) can. This is a very common procedure. Removing the appendix should not affect your long-term health. It�s best to remove the appendix before it bursts. If an infected or burst appendix is not removed, it can cause severe health problems.

Appendectomy

The goal of appendectomy is to remove the appendix safely. In most cases, the surgery lasts from 30-60 minutes. If your appendix has burst, surgery may take longer.

Before Surgery

You may receive fluids, antibiotics, and other medications through an IV (intravenous) line. Tell your doctor if you are allergic to any medications. An anesthesiologist or nurse anesthetist will give you general anesthesia just before your appendectomy. This keeps you pain-free and allows you to sleep during the surgery.

Reaching the Appendix

One of two techniques may be used to reach the appendix. Your surgeon will discuss which is best for you.

Open surgery: One incision (about 2 to 3 inches long) is made in your lower right side. A bigger incision may be used if the appendix has burst.
Laparoscopic surgery: From 2 to 4 small incisions are used. One is near your bellybutton. The others are elsewhere on your abdomen. A laparoscope, a thin tube with a camera attached, is inserted through one incision. The camera shows the inside of your abdomen on a monitor. This image helps guide the surgery. Surgical tools are inserted in the other incisions.

Finishing the Surgery

In most cases, the entire incision is closed with stitches or staples. Your surgeon may place a temporary drain in the wound or in the abdomen. This helps cure or prevent infection. If your appendix has burst, the outer layers of the incision may be left open. This lets the incision drain more easily. It may heal on its own, or be closed about 5 days later.

Risks and Complications

Infection or bleeding from the incision site
Infection or swelling in the abdomen, or leakage of bowel material
Bowel ileus (slowness of bowel muscles) or bowel blockage
Problems from anesthesia

After an Appendectomy

Most patients recover quickly after appendectomy. You will likely be in the hospital for 1 - 2 days. If your appendix burst you may stay longer. After you return home, plan on a follow-up visit to the doctor in 1 - 2 weeks.

In the Hospital

In most cases, you will drink liquids and walk on the day of the surgery. You will also receive pain medication. To help keep your lungs clear, you may be taught breathing exercises.

Back at Home

FEVER

Low grade temperatures (99-100.5degrees) are common in the first 2-3 days after surgery, especially if you have had general anesthesia. The best treatment is coughing, deep breathing, and use of the incentive spirometer from the hospital (if you were given one). Higher or persistent temperatures warrant notification of our office.

You will start walking very soon after surgery. Walking helps you recover faster and helps prevent complications.

BOWEL MOVEMENTS

Bowel movements are commonly altered after surgery. If you received even one dose of antibiotics, you may develop several days of diarrhea after surgery. If so, eating yogurt may help this condition. If the diarrhea is foul-smelling, very frequent, or associated with fever, please notify our office. More often, the combination of anesthesia and pain medication (especially after bowel surgery) can cause severe constipation for up to a week. This may be treated with Metamucil each day, plus Milk of Magnesia if needed. Stubborn cases may benefit from Citrate of Magnesia or Fleets enemas. If you have had intestinal surgery, do not use an enema without clearance from your surgeon. Call the office if you have exhausted all of these methods.

PAIN

Surgery hurts! The bigger the operation, the more it hurts. One of the reasons for the hospital stay in larger operations is for pain control with IV medications. In smaller operations, or after several days in the hospital, the pain can usually be well controlled with oral medications. Narcotics such as Percocet, Vicodin, and Tylenol #3 are fairly powerful medications that usually control pain very effectively. However, they have frequent side effects such as dizziness, nausea, and constipation. We recommend treating your postoperative pain initially with Ibuprofen (such as Motrin, Advil, or generic) 600-800 mg with food 3 times a day. Take this medication until your pain subsides to the point that you don�t need medication any more.

In addition to the Ibuprofen, take your prescription medication as directed for the first few days if needed. Do not take Ibuprofen if you are allergic to that family of drugs, if you take blood thinners, or if you have had stomach ulcers or gastric surgery. Do not drive if you are taking narcotics. Do not mix alcohol with narcotics.

WOUNDS

Surgical incisions usually require little care. Inpatient surgical incisions are often closed with staples or external sutures. These are usually removed after 5-10 days, often in the office. You will be told in the hospital when you can get the incision wet. Typically showers are allowed after 3 days and tub baths after the sutures are removed. Outpatient or overnight-stay surgical incisions are often closed with dissolving sutures. Steri-strips are then applied to the skin. These may be exposed to the shower the next day, but tub bathing and scrubbing should be avoided for a week. Pinkish or clear discharge is common for 2-3 days after surgery. Thick yellow or foul-smelling discharge, or frank bleeding, should prompt a call to the office. Dissolving sutures typically take 3 weeks to disappear. If they protrude from the skin they may itch, and you may call the office for an appointment to have them trimmed. In a few cases, a blood collection in the wound (hematoma) or a wound infection may cause the edges of the wound to separate. This is usually a simple problem to deal with in the office; call for an appointment if this happens. In some situations wounds are not completely closed. These will be managed by dressing changes several times a day (visiting nurses may be arranged in complex cases), often for several weeks.

BANDAGES

Band aids may be applied to small incisions. They should be removed the next day or changed as desired. If there are small white tapes on the incision under the band aids (steri-strips or "butterfly" bandages), these should be left on until they begin to fall off in 7-10 days. They may get wet 24 hours after surgery. Larger incisions may have gauze taped over them. This can usually be removed 48 hours after surgery. All wounds may be covered with clean bandages (changed daily) if they are tender or chafed by clothes.

FOLLOW UP

You will be seen in our office 7 to 10 days after your surgery and again in several weeks. Prior to surgery, you should have made an appointment for your first post-operative visit. If for some reason that appointment was not scheduled, please call our office at (703) 359-8640 as soon as your return home to schedule your appointment.

IF DIFFICULTIES ARISE

You may have trouble belching or vomiting for several weeks after surgery. This will subside as your body adjusts to the operation. Please call our office immediately if you develop any of the following; chest pain, excessive drainage, fever over 100°F, persistent nausea or vomiting, or difficulty with urination. Please call us if other problems or questions arise. We can be reached any time, including evenings and weekends, by calling our office number (703) 359-8640.

To help control pain from surgery, take your medications as directed. Avoid strenuous activity, heavy lifting, and driving until your surgeon says it is OK. As instructed, slowly resume your normal activities in 7 - 10 days.