Laparoscopic Appendectomy

PATIENT EDUCATION Laparoscopic Appendectomy

How do you remove the appendix? How long does it take?

Removal of the appendix is typically done with three small incisions and with use of a camera (also known as “laparoscopic”). It is able to be done this way most of the time. Occasionally we need to make a larger incision to remove the appendix. This is more likely if the appendix is very inflamed or if you have had previous surgery in your lower abdomen. The surgery usually takes about an hour.

What are the risks of the surgery?

Every surgery has risks of bleeding, infection, and damage to surrounding structures. These risks are all relatively low. What is an appendix? The structures around the appendix include surrounding bowel and blood vessels. There is also a small risk of an appendiceal stump leak if the area where the appendix The appendix is a small appendage that is divided does not heal properly or if it is not adequately is connected to the first part of the colon. sealed. There is also a small risk of hernia formation at the incision sites, but this is less common when the surgery is Although the purpose of the appendix is done laparoscopically. unclear in humans, in other animals it is thought to have an immune function. It is How long is recovery? located in the right lower abdomen.

If your appendix is not perforated, you can typically go home the same day or within around 12 hours of surgery. Who needs their appendix However, if the appendix is perforated you may have a slowing down of your intestines called an “ileus.” This just removed? takes time to resolve and you may be in the hospital 3-5 days depending on when this ileus resolves. People who have an inflamed but not perforated appendix will have the appendix removed. If the appendix is At home, you can expect to need to take the first week perforated, most of the time we will treat that person with easy and you will likely still feel effects of the surgery for antibiotics and we may need to take the appendix out the first month, such as slight pain around your incisions, a later. This is done to avoid a more extensive, and potentially decreased appetite, and some decreased energy. Everyone more damaging surgery at the initial time of perforation. is a little different on how long they feel these effects but Occasionally if the perforation is severe, we will need to most people start doing their normal routines with some perform surgery to wash out the abdomen and place and modifications 2-5 days after surgery. It is ok if it takes longer drain and then go back later to take the appendix out. for you. If you need an “open” procedure where we need to make a larger incision, your recovery will be a little longer because of the size of the incision and because it usually means that there was more inflammation around the appendix and we needed the larger incision in order to get it out.

What pain can I expect after surgery and how do I manage it? What medicines should I take?

You will likely experience some pain around your incisions and in your right lower abdomen where your appendix was. Sometimes people feel some soreness in their shoulders after laparoscopic surgery. This is due to the gas that is used to do the surgery and it typically resolves in around 2-3 days. It is normal to feel sore around your incisions and abdomen for longer than this and everyone’s body takes a slightly different Can I drive after the surgery? amount of time to recover. You can drive when you are off narcotic pain medications To manage the pain, unless instructed otherwise, take 1000 (such as Oxycodone, Percocet, Norco, Tylenol #3) and when mg (2 tabs) of Extra Strength Tylenol/acetaminophen every you feel you can twist and turn as you would need to in an 6 hours around the clock for the first 2-3 days. Do not emergency situation. Typically people wait 2-3 days but it exceed 4000 mg of acetaminophen in one day as this may may take longer. be harmful to your liver. You can also take 600 mg (3 tabs) of Advil/Motrin/ibuprofen every 6 hours with some food. Use ice packs and hot packs to help with the pain as well. Double When can I go back to work after check with your surgeon if you have issues with your liver or surgery? kidneys. It depends what kind of work you do. If you have a desk job, If the above medications are not enough, take the narcotic most people feel ready to go back after about 5-7 days. If medicine (Oxycodone or alternative) as prescribed. You will your job requires heavy lifting and you cannot go back on receive this prescription when you leave the hospital. Be “light duty” then talk to your surgeon. We can provide work careful if your narcotic medication is a combination pill that notes as needed. has Tylenol/acetaminophen in it such as Percocet. See above.

If you take more than a day of the narcotic medication, make sure that you take an over-the-counter stool softener such as How do I care for my incisions? Miralax 1-2 times per day or Colace 100 mg 1-2 times per day to Can I shower? Can I take off my keep from becoming constipated from the narcotic pain pills. bandages?

If you have bandages over your incision, you can take them What activity can I do after surgery? off the day after surgery. There are typically white stickers under the bandages called “Steri-strips.” These fall off on You should try to avoid lifting heavy objects (greater than 20 their own. You can shower with them on but don’t scrub lbs) for the first 2 weeks. After this time frame you can start them and pat them dry. to lift more. There is no strict time frame but try to listen to your body. If you start to lift something and it hurts – stop! If If you have skin glue over your incisions, you do not need your job requires heavy lifting, talk to our office about a work to take anything off and everyone can shower the day after excuse note. surgery. Don’t swim or take a bath for 2 weeks after surgery. What should I eat after surgery?

S. Maple St. You may not feel hungry all the time or you may eat a small Milford Ave.

amount and feel full. This is ok. Some people find eating Plum Street multiple small meals is easier than 3 large meals. Continue to Stocksdale Dr. drink lots of fluids. E. 11th St. Walnut Street

What should I look out for Milford Ave. Memorial Outpatient Surgery Center after surgery?

• Fever of 101.5o F or higher Where are theyProfessional performed? Pkwy

• Leg swelling We perform laparoscopic appendectomies in Marysville at • Shortness of breath Memorial Hospital. Directions will be supplied by nursing staff on booking the procedure and clarified as needed on • Chest pain your call the day prior to your laparoscopic appendectomy. • Dizziness/lightheadedness/fainting • Redness expanding around your incisions or pus Memorial Hospital draining from your incisions (some clear yellow/red 500 London Ave, Marysville drainage can be normal) 937 644 6115 • Increasing pain around where your appendix was • Increasing abdominal bloating/distention/nausea/ vomiting

When should I call for help? Who should I call?

If you notice any of the above symptoms, call the number listed on this form. If it is after hours you can ask to speak to the surgeon on-call. If it is a more minor issue, you can call and talk to one of the nurses during business hours the next day. However, if you have sudden severe chest pain, shortness of breath, or are feeling increasingly sick or lightheaded, you should call 911 and be taken to the emergency room right away.

937 578 2650 memorialohio.com Rev 5-19 140 Coleman’s Crossing, Marysville, OH 43040