Appendix

Appendix Surgery

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.

What is the Appendix?

The appendix is a small hollow outpouching located in the right lower side of the abdomen, the size of your little finger; it is attached to the area where the small intestine meets the large intestine or colon. The actual function of the appendix is still unknown, however surgical removal of the appendix is well tolerated and of no clinical implications on long-term patients health.

Pain & Other Symptoms

The opening of the appendix into the large intestine can get blocked by hard stool, tumors, thick mucus, or inflammatory diseases. Once obstructed, the wall of the appendix gets swollen, blood supply to the appendix gets cut off, and bacteria start growing inside the appendix causing inflammation and infection of the appendix. If left untreated, the swollen appendix can rupture causing spillage of stool into the abdomen and resulting in a generalized infection of the abdomen. Surgical removal of the appendix remains the gold standard treatment of appendicitis before it bursts.

Pain & Other Symptoms

Non-Surgical Treatment of Appendicitis

Uncomplicated early appendicitis may be treated with antibiotics alone. This is done in some European countries, and not favored in the United States, as it confers a high risk of recurrence and is only effective in two thirds of the cases.

Appendix Surgery: Laparoscopic Appendectomy

If you get diagnosed with appendicitis, a surgeon must be emergently consulted for a surgical removal of the appendix, also known as appendectomy. Patients who have this procedure done with the camera technique or laparoscopic appendectomy, usually recover more quickly and have less pain than with open surgery.

The goal of an 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:

Finishing the Surgery

In most cases, the incision(s) will be closed internally with glue or tapes on the skin. 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 & Complications

After an Appendectomy

Most patients recover quickly after appendectomy. You will likely be in the hospital for less than 24 hours, and may not even need a bed in the hospital. 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.

Discharge Instructions after Appendix Surgery

You just had your appendix removed laparoscopically. This is a procedure performed through several small incisions. After surgery, be sure to have an adult drive you home and follow the guidelines on this sheet. Make a follow-up appointment as directed by our staff.

Activity:

We encourage resuming walking and light activity immediately; as soon as you are sure you are not going to have issues with dizziness or lightheadedness.  You may resume driving when it is comfortable to walk up and down stairs.  Don’t plan on any strenuous activities, like sports or going to the gym, until your postop appointment.  Your surgeon may have specific instructions to add to this; usually these are outlined to you before surgery.  The bottom line:  if it hurts, don’t do it!

Driving should not be attempted until you are off pain medications and able to go up and down stairs comfortably.  You should be able to slam on the brakes to avoid an accident without causing any pain.

Eating:

The basic rule is take in what your body is telling you.  Unless you have been given a specific diet plan, you may eat what you wish, even the day of surgery.  Beware of nausea or queasiness the day of surgery, though.  Some find it easier to digest bland foods, light foods, or predominantly liquids that evening.  As you feel better, however, you can eat whatever seems good to you. We suggest a low fat diet until you return for your postop appointment.  Make sure you stay hydrated, and avoid excessive caffeine.  Also, no alcohol if you are taking prescription pain medications.

Elimination:

Constipation is very common after surgery.  We recommend staying well hydrated, and using Miralax, prune juice, or Milk of Magnesia for a few days until things are back to normal.  If you are at all prone to constipation, or if you need several days of pain medicine, it may help to add Benefiber, Metamucil or similar bulk fiber agents for a few days as well.  Do not let more than 48 hours go by without a bowel movement without starting the above medications.  If they fail to help within another 24 hours, call our office. Diarrhea is common if you are taking antibiotics.  If you have this problem, we would suggest either probiotics while you are on the antibiotics, or eating yogurt with active cultures.  If diarrhea occurs more than 4-6 times daily for more than 48 hours, call us. You should be able to urinate within 6-8 hours of leaving the facility.  If you are unable to do so, call our office.  Make sure your doctor is aware of any chronic difficulties with urination (like prostate trouble) before surgery.

Wound care:

Usually surgical wounds will have either glue or steri-strips (butterfly tapes) on them, often covered with gauze.  Glue, steri-strips, or waterproof plastic dressings can all get wet the day after surgery (unless your surgeon advises differently).  Wounds with visible staples or sutures can get wet in the shower after 48 hours.  Do not submerge your wound (tub bathing or swimming) for one week.  While soap will not harm the wound, do not scrub it.  Do not apply peroxide or other chemicals unless you have been told to do so by your doctor.  After 48 hours, change or remove gauze dressings or Band-aids.  Do not leave soiled or wet dressings on the wound beyond 48 hours.  Most wounds can then remain uncovered, unless you have been told otherwise.  Light gauze covering to prevent chafing is acceptable if you wish.  You may notice a slight drainage (usually pink or reddish in color) from the incision site.  This is normal and not a cause for concern.  Light pinkness immediately surrounding the incision, and not spreading over time, is normal.  Bruising is common and may extend for up to an inch.  Spreading redness, progressive swelling with bruising, and malodorous drainage are not normal and should prompt a call to our office.

Drains:

If you are sent home with surgical drains, you will likely be given instructions at the time of discharge for care of them, and a log sheet to record the output.  It is important to note the daily output of the drain(s) so we will know when to remove them.  Drains that empty into a suction bulb or attached bag can get wet in the shower.  If there is gapping of the skin around the drain, Neosporin or similar ointment may be used to protect the area while you shower.  Do not submerge the drain site underwater, such as tub bathing or swimming.  Slight pinkish or yellowish drainage from around the tube is normal while it is in place, as is a small amount of redness at the site.  Gauze over the site may help protect your clothing from staining.  Foul smelling or copious drainage around the drain, or spreading redness around the drain, is not normal and should prompt a call to our office.  If the drain reservoir fails to hold suction when you squeeze it, or if the drainage suddenly drops to near zero, call our office.

Normal care of drains includes emptying the fluid in the reservoir every 8 hours and recording the amount per 24 hour period.  Bring this record to your postoperative appointment.  The fluid may need to be emptied more frequently if the drainage is heavy.  Fluid will often be red at first, then pink, then yellow as the wound heals.  Stringy material in the tubing or reservoir is normal.

Medications:

Use over-the-counter pain medications or a prescribed narcotic for your discomfort as needed. We recommend the following: Tylenol 1000 mg every 6 hrs around the clock for 2-3 days, in addition to Motrin/Advil/Ibuprofen 400-600 mg every 8 hrs and alternate these with Tylenol. Unless you are told differently by your surgeon or primary doctor, you can take 400 mg ibuprofen every 4-6 hours, or 800 mg every 8 hours, for the first 3-5 days after surgery, for a maximum dose of about 2400 mg/day (refer to the label for specific dosing based on age and weight).  It is best if you can take some food with this medication. Tylenol is also acceptable to help with the baseline pain after surgery.  It can be taken in conjunction with ibuprofen, and with your prescription (unless your prescription already contains acetaminophen--which is Tylenol).  Be very careful not to exceed the dosage on the bottle.  Taking more than 3 grams/day is not advisable. Most patients will be given a prescription for narcotics, if needed, but most will not need it. Prescription narcotic pain medications are there to help you recover comfortably, but stop them as soon as you are able.  Side effects of nausea, vomiting, dizziness, fatigue, poor appetite, and above all constipation, are common.  Do not use alcohol or drive if you are taking prescription pain medications. Blood thinners should only be restarted after surgery according to the plan discussed with you by your surgeon or prescribing doctor before surgery.  If this was not made clear to you, call our office. All other medications should be resumed once you get home.  Vitamins and supplements are not necessary to help you heal, unless you have a known deficiency.  You may resume them after you get home if you wish.  We would suggest sleep aids not be used while you are on narcotic pain medications.

If Difficulties Arise:

Please call us if any problems or questions arise.  We can be reached any time, including evenings and weekends, by calling our office number (703) 359-8640 and selecting to speak to the on call physician.

Call your doctor if you have any of the following: