Appendectomy is a surgery that is done to remove appendix when it gets infected, a condition referred to as appendicitis. The appendix is located in the right lower part of the belly and is a thin small bag attached to large intestine. In appendicitis, removal of appendix is required immediately as without treatment it may burst. There are two types of appendectomy-open appendectomy (standard method) and laparoscopic appendectomy (less invasive, newer method). Appendectomy is an emergency surgery and quite commonly performed. Usually, there are no complications of the surgery; however, in some cases there may be some complications.
Though appendectomy is relatively free of risks, still some complications may develop. The common complications are as follows:
1. Paralytic Ileus
Under normal conditions, the intestine is under constant systematic and rhythmic motion. During surgery, the intestine may get disturbed, resulting in paralysis of movements. This leads to accumulation of gases and fluids in the intestine, causing its swelling. This complication more commonly occurs when the surgery is done to remove a perforated appendix. There is intravenous administration of fluids and food and a nasogastric tube is passed through the nose in the stomach to relieve the condition.
2. Wound Infection
The skin surrounding the closed incision may get infected, inflamed and filled with pus. You may be prescribed antibiotics depending on the severity of infection. In case there is no improvement, the surgeon may reopen the incision to drain it of toxins and pus.
In some individuals pain may occur in the shoulders as one of the appendectomy complications, particularly post laparoscopic appendectomy. This occurs as a result of carbon dioxide gas which is pumped in the abdomen during the procedure. The condition usually gets better in one or two days on its own. However, chronic pain in abdomen may occur in some people and it may last for even months. In such cases narcotics such as Vicodin, Oxycodone, and Percocet etc. are usually prescribed.
It is very important to consume these medicines according to instructions. These medicines may cause drowsiness; hence, activities including driving must be avoided. Don’t drink alcohol with these medicines and consume them along with meals to prevent nausea. Visit a physician if you develop any symptoms such as rash.
Narcotics and paralytic ileus may result in slowing down of bowel movements leading to constipation. To prevent constipation, you should take stool softeners before appendectomy as recommended by your surgeon.
Guidelines on Recovery After Appendectomy
After discussing appendectomy complications, let’s discuss certain guidelines on recovery after appendectomy.
The time required for recovery after appendectomy is quite variable. It depends on type of surgery done, type of anesthesia used, and whether any complications have developed or not. For instance, laparoscopic appendectomy can be performed on outpatient basis and the patient may be discharged so that they can recover at their home, whereas in open surgery stay in the hospital for one night or longer time may be required after which the patient can go home. You may resume normal activities in few days; however, you may require four to six weeks for full recovery and during this time you should avoid strenuous activities.
- You should always wash hands after and before touching the site of incision.
- You should not soak in bathtub till the Steri-Strips or stitches are removed. You can take shower after second day post surgery unless you are advised against it.
- The instructions of surgeon should be followed regarding the time to change bandages.
- It is normal to have small quantity of drainage from incision. If drainage becomes yellow and thick or the site becomes red it may indicate an infection; hence, you should call the surgeon.
- A drain in the incision is taken out after the stoppage of drainage.
- Steri-strips usually fall off in seven to 10 days.
- If glue like covering is present on the incision, let the glue flake off slowly on its own.
- Don’t wear rough or tight clothing.
- Protect new skin, particularly from sun.
- The scar may heal in around 4-6 weeks.
- Sensation around the incision may return in few weeks to months.
- After waking up, you can drink small quantities of fluids. You may start eating normal food if you are not feeling sick.
- Drink plenty of fluids, generally around 8-10 glasses each day.
- Consume a diet rich in fiber so that you don’t have to strain while passing stool.
- Increase activity slowly. Ensure to get out of bed and take a short walk every one hour to prevent formation of blood clots.
- Avoid doing strenuous activities for 3-5 days post laparoscopic procedure and 10-14 days post open procedure.
- You can go home after 1-2 days post laparoscopic procedure. If you had a ruptured appendix or there are other complications or health problems, you may be required to stay longer.
- You may feel tired, which is normal. You may sleep more than normal.
Return to Work and School
- You may return to work when you become and feel well. You may discuss this with the surgeon.
- Children may attend their school one week after surgery for unruptured appendix and about two weeks post surgery for ruptured appendix.
- Majority of the children should not go back to sports, climbing games and gym class for two to four weeks post surgery.
- Loose watery stools may be present for few days post surgery. If they are present for more than three days, visit your surgeon.
- Eat a diet rich in fiber to avoid constipation. You may also be prescribed stool softeners.
Each person has a different reaction to pain. A scale of 0 to 10 is utilized to measure pain. At 0, no pain is felt, while at 10, the worst pain is felt.
- Common Medicines
Opioids or narcotics are utilized for pain that is severe. Possible adverse effects are reduced blood pressure, breathing rate and heart rate, sleepiness, itching and skin rash, nausea, difficulty in urination and constipation. There are medicines that control these adverse effects of narcotics.
- Non-Narcotics Medicines
Majority of the non-narcotics pain medicines are NSAIDs (nonsteroidal anti-inflammatory drugs). They are utilized for inflammation and mild pain or used in association with a narcotic for severe pain. Certain adverse effects of NSAIDs include bleeding in gut, fluid retention, and stomach upset. They are not present when NSAIDs are used for short term. Some examples are ibuprofen, Aleve, Toradol, and Motrin.
When to Visit Your Surgeon?
In case you have the following:
- Pain that does not go away
- Pain that worsens
- High temperature of greater than 101 degree F (38.3 degree C)
- Vomiting (repeated)
- Redness, bleeding, swelling, or drainage (bad smelling) from wound
- Severe pain in abdomen
- Not passing stool or not able to pass gas for three days
- Loose stools for more than three days