Laparoscopic Appendectomy

Introduction

Appendectomy is the surgical removal of the appendix. The operation is done to remove an infected appendix, called appendicitis. This can burst and release bacteria and stool into the abdomen.

Indications

• Abdominal pain that starts around the naval and often moves down to the lower right side of the abdomen.
• Not wanting to eat.
• Low fever.
• Nausea and sometimes vomiting.
• Diarrhea and/or constipation.

Procedure

The laparoscopic technique is the most common procedure for simply appendicitis. Port size incisions will be made in the abdomen to insert the ports. The abdomen will be inflated by carbon-dioxide gas so that Dr Daoud can see the appendix more easily.

The appendix will be removed and the area is washed out with sterile fluid to decrease the risk of further infection. The carbon-dioxide gas will make its way out of the incision sites and the sites are closed using sutures or staples. Dr Daoud may need to start with a laparoscopic approach and later convert to an open approach for your own safety.

Post-operative Instructions

Pain

Post-operative pain is normal but the intensity can differ between individuals. Analgesia will be given to you during your hospital stay and made available to you on your discharge if still required. You may experience some pain on the tip of your shoulders due to air under your diaphragm. This is normal after this procedure and gentle walking will ease this. The pain should wear off within 4 to 5 days. Please read section “Medication”.

Wound/sutures

The dressing over your naval wound will be removed and left open the day after your surgery. The other wounds are to be kept clean and dry. The dressings may be removed the day after your discharge or replaced with a clean dressing for 2-3 days and then left open. Your sutures are dissolvable and are not required to be removed.

Diet

You will be able to have ice chips 4 hours after your operation and sips of fluid if desired. Normal fluid intake and a low-fat diet is usually commenced on the day after your operation. It is advisable to continue on a low-fat diet for 4 weeks after your surgery.

Nausea and vomitting

Some people are very sensitive to surgical procedures. Nausea and vomiting may occur as a result of the general anaesthesia, the procedure performed or the medications prescribed. If you have nausea and vomiting please do the following:

• Keep well hydrated with frequent small drinks of clear fluids. It is recommended that you drink water, lemonade or diluted fruit juice. Avoid milk.
• Cease your medications as in most cases the nausea and/or vomiting is related to the pain killers prescribed. Once these have been ceased the nausea and/or vomiting will usually resolve.
• Contact Dr Daoud’s office at Greenslopes if the nausea and/or vomiting persist.

Medication

You will generally be prescribed pain killers. It is imperative that you notify Dr Daoud of any allergies you have to medications. If you are taking medications prescribed by your doctor you need to return to your normal dosage schedule as soon as possible after surgery unless directed otherwise. If you are having trouble with the bowel motions you may require an over-the-counter laxative preparation, such as Movicol.

Activities

24 hours after your surgery you MUST NOT drive any motor vehicle or operate machinery. You MUST NOT undertake any important new projects, make important decisions or sign legal documents. You MUST NOT drink any alcohol. Alcohol and prescribed medication is a dangerous mix. You may be able to resume light activities within a few days. You can walk about as much as you wish. You can commence cardio exercise 2 weeks after the operation. No swimming until the wounds are completely healed.

Return to work/school

This will depend on the type of work you do. You can usually expect to return to work within 1-2 weeks. If you require a medical certificate, please call Dr Daoud’s office after your surgery and one will be arranged.

Post-operative appointment

You will need to contact Dr Daoud’s office once you are discharged to make a Post-operative appointment for 2 weeks after your surgery.

Infection

If you develop a post-operative infection remember it will not generally appear until one to two weeks after the operation. If this does occur, please call Dr Daoud’s office to book a review appointment. You will normally be prescribed a course of antibiotics.

It is important that the full course of antibiotics is completed.

Problems

Post-operative complications such as infection, unusual pain, etc are uncommon but if they do occur please contact Dr Daoud for advice.

Special issues of concern:

Please feel free to call Dr Daoud’s rooms during office hours or mobile after hours if any doubt arises as to your progress or recovery, especially if any of the following occurs:

• Increasing or persistent pain after 4 or 5 days.
• Any swelling around the wound site.
• Persistent nausea or vomiting.
• Persistent discharge from the wound site.

Please do not call the referring doctor, or your local GP before you contact Dr Daoud’s office. The office number is 07 3397 8499 and they are open from Monday to Friday 8:30am-5:00pm.

Risks/Complications

• Secretions may collect in the lungs causing a chest infection.
• Clotting may occur in the deep veins of the legs. Rarely part of this clot may break off and travel to the lungs. This can be life threatening.
• Circulations problems to the heart or brain may occur which could result in a heart attack or stroke.
• Death is possible during or after an operation due to severe complications.
• No resolution of the pain.
• Formation of abscess.
• Infection of the wound or at the surgical site.
• Hernia at the incision site after surgery.
• Pelvic collection.
• Bowel injury- formation of stoma, re-operations and scar formation.
• Treatment Alternatives
• Laparoscopic appendectomy- The appendix is removed with instruments placed into small abdominal incisions.
• Open appendectomy- the appendix is removed through an incision in the lower right abdomen.
• Non-surgical- surgery is the only option for an acute (sudden) infection of the appendix.