Appendectomy

WHAT YOU SHOULD KNOW

• Open Appendectomy: This is the traditional approach, in which the doctor removes the appendix through a large incision in the lower right-hand side of the abdomen.
• Laparoscopic (LAP-er-uh-SKAH-pik) Appendectomy: In this newer type of procedure, the surgeon works through three small incisions in the abdomen instead of a single large one. Watching through a long tube equipped with a tiny lens and light, he maneuvers miniature surgical instruments into the abdomen and over to the appendix, which is then snipped off and pulled out. To give the surgeon an unobstructed view, the abdomen is inflated with carbon dioxide, which may leave you with shoulder pain for the first 2 days after the operation.

Risks

IF YOU'RE HEADING FOR THE HOSPITAL...

Before You Go

• To keep abdominal pain to a minimum, stay quietly seated in a chair.
• Check with your doctor before taking pain-killers or any of your regular medications.
• You should not have anything to eat or drink just before surgery. Ask your doctor when to begin fasting.
• Do not wear contact lenses to the hospital. You may wear your glasses.

What to Expect While You're There

• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• Blood Tests: You may need blood taken for tests. It can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
• Chest X-ray: The doctor will check this picture of your lungs and heart to make sure you're ready for the stress of surgery.
• Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Typically, three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat.
• IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
• Pulse Oximeter: With a little clip connected to your ear, finger, or toe, this machine measures the oxygen in your blood.
• General Anesthesia: You'll be kept completely unconscious during the surgery. The anesthetics can be given either as a liquid in your IV or as a gas through a face mask or endotracheal (END-o-TRA-kee-ull) tube placed in your mouth and throat.

After Surgery:

• Oxygen: At times after the operation, your body may need extra oxygen. It is given either through a plastic mask over your mouth and nose or through nasal prongs. If the oxygen dries out your nose or the nasal prongs bother you, tell your nurse, but don't take off the oxygen on your own.
• Deep Breathing and Coughing: These exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs and keep them clear. You should deep breathe and cough every hour while you are awake, including any time you spend awake during the night.
     Hold a pillow tightly against your abdomen to help reduce pain from your incisions. Take a deep breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Incentive spirometer (spy-ROM-uh-tur): This piece of equipment helps you take deeper breaths. Put the plastic nozzle into your mouth, take a very deep breath, and hold it as long as possible. Then blow as hard as you can into the mouthpiece. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Drains: Thin rubber tubes may be put into the area around your incisions to drain off excess fluid. They will be taken out when no longer needed.
• Pressure Stockings: These tight elastic stockings keep blood from collecting in the legs and causing clots.
• Pneumatic Boots: For extra insurance against blood clots, these plastic boots or leggings are applied over pressure stockings or ace wraps and connected to an air pump machine. The pump rhythmically tightens and loosens different parts of the boots, helping to push the blood back up to the heart.
• Activity: Even when you're confined to bed, it's important to exercise your legs in order to stop blood clots from forming. Lift one leg off the bed and draw big circles with your toes, then repeat with the other leg. You can also try lying on your side and pretending to pedal a bike. When you're told it's OK to get out of bed, make sure someone is with you the first time you try. If you feel weak or dizzy, sit or lie down right away.
• Nasogastric Tube: This type of tube, also called an NG tube, is threaded through your nose and throat and down into your stomach. It is attached to suction, which will keep your stomach empty. It may also help to get your bowels working. Food or medicine is sometimes given through the tube.
• Eating: When your doctor can hear bowel sounds (stomach growling) through a stethoscope, you'll be able to eat. You will probably get ice chips first and then liquids (water, broth, apple juice, or soda). If you do not have problems with the liquids, you'll then be allowed to eat soft foods such as ice cream, applesauce, or custard. If these foods agree with you, you can return to a regular diet.
• Bowel Movements: Regular bowel movements can be difficult after surgery. Don't strain if the stool is too hard. Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran, cereal, and beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
• Strict Intake/Output: Your doctor may need to know the amount of liquid you are taking in versus the amount you lose in your urine. This is often called an "I&O."
• • Unless told otherwise, drink 6 to 8 large glasses of water each day. Keep a record of exactly how much liquid you drink.
  • Your output of urine may have to be measured. Ask your doctor whether it's OK to use the toilet.
• Medicines:
• • Antibiotics: These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
  • Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
  • Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
  • Stool Softeners: These medications make bowel movements softer so you won't need to strain.

After You Leave

• Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up, even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
• For pain or swelling, you may put ice in a plastic bag, cover it with a towel, and place it over the incisions for 15 to 20 minutes out of every hour as long as necessary. Do not sleep on the ice pack. Treatment with ice is most effective when started right after the operation and used for 24 to 48 hours.
• After the first 24 to 48 hours you may use heat for pain or swelling. Apply a heating pad (turned on low) or a hot water bottle, or sit in a warm water bath for 15 to 20 minutes out of every hour as long as you need relief. Do not sleep on the heating pad or hot water bottle. Heat brings blood to the area of the operation and helps it heal faster.
• When you are allowed to bathe or shower, carefully wash the stitches or staples with soap and water. Then put on a clean, new bandage. Change your bandage any time it gets wet or dirty.
• You'll need extra rest while you recuperate. Try to gradually increase your activity each day, resting whenever you feel it's needed. Avoid any heavy lifting until your doctor gives the OK.

Call Your Doctor If...

• Your incision is swollen and red, or you see any pus. These are signs of infection.
• Your stitches or staples come apart.
• Your bandage becomes soaked with blood.
• You develop a high temperature.
• The pain in your abdomen gets worse.

Seek Care Immediately If...

• You suddenly have trouble breathing or start having chest pain. You could have a blood clot in your lung or an allergy to one of your medicines.