APPENDECTOMY

APPENDECTOMY INTRODUCTION Appendectomy is a surgery to remove the appendix. The appendix is a small pouch that comes off the large intestine. The appendix sometimes gets blocked and becomes infected and swollen. Signs of an infected appendix include abdominal pain in the lower right side, fever, poor appetite, nausea and vomiting. If the appendix bursts, it can make you very sick. There are two ways to do this surgery: Open appendectomy a single incision is made in the abdomen. The doctor works through this larger incision to remove the appendix.

Laparoscopic appendectomy - 3 or 4 small incisions are made in the abdomen. The doctor uses a camera and tools through the small incisions to remove the appendix. With this type of surgery, you may recover faster, have less pain, less scarring, fewer wound problems and often spends less time in the hospital.

HOW IT IS DONE? During an appendectomy, an incision two to three inches in length is made through the skin and the layers of the abdominal wall in the area of the appendix. The surgeon enters the abdomen and looks for the appendix, usually located in the right lower abdomen. After examining the area around the appendix to be certain that no additional problem is present, the appendix is removed. This is done by freeing the appendix from its attachment to the abdomen and to the colon, cutting the appendix from the colon, and sewing the over the hole in the colon. If an abscess is present, the pus can be drained with drains (rubber tubes) that go from the abscess and out through the skin. The abdominal incision then is closed. Newer techniques for removing the appendix involve the use of the laparoscope.

The laparoscope is a thin telescope attached to a video camera that allows the surgeon to inspect the inside of the abdomen through a small puncture wound (instead of a larger incision). If appendicitis is found, the appendix can be

removed with special instruments that can be passed into the abdomen, just like the laparoscope, through small puncture wounds. The benefits of the laparoscopic technique include less post-operative pain (since much of the post-surgery pain comes from incisions) and a speedier recovery. An additional advantage of laparoscopy is that it allows the surgeon to look inside the abdomen to make a clear diagnosis in cases in which the diagnosis of appendicitis is in doubt. For example, laparoscopy is especially helpful in menstruating women in whom a rupture of an ovarian cysts may mimic appendicitis. If the appendix is not ruptured (perforated) at the time of surgery, the patient generally is sent home from the hospital in one or two days. Patients whose appendix has perforated generally are sicker than patients without perforation. After surgery, their hospital stay often is prolonged (four to seven days), particularly if peritonitis has occurred. Intravenous antibiotics are given in the hospital to fight infection and assist in resolving any abscess If the appendix is not ruptured (perforated) at the time of surgery, the patient generally is sent home from the hospital in one or two days. Patients whose appendix has perforated generally are sicker than patients without perforation. After surgery, their hospital stay often is prolonged (four to seven days), particularly if peritonitis has occurred. Intravenous antibiotics are given in the hospital to fight infection and assist in resolving any abscess

PREOPERATIVE CARE All diagnostic tests and procedures are explained to promote cooperation and relaxation. The patient is prepared for the type of surgical procedures as well as the post operative care. Measures to prevent postoperative complication are taught, including coughing, turning, and deep breathing using splint at the incision site. I.V fluids or total parenteral nutrition before surgery maybe ordered to improved fluid and electrolyte balance and nutritional status. Intake and output is monitored. Preoperative laboratory are obtained. Bowel cleansing will be initiated 1 to 2 days before surgery for better visualization. Antibiotics are ordered to decrease the bacterial growth in the colon. Patient may not have anything by mouth after midnight the night before surgery. Medication may be withheld, if ordered. This will keep the GI tract clear. INTRAOPERATIVE CARE Position the patient on the OR table Skin preparation Induction of anesthesia Procedures done aseptically Closing of the incision Dressing of the site POST OPERATIVE CARE Monitor vital signs for sign of infection and shock such as fever, hypotension and tachycardia. Monitor I and O for sign of imbalance, dehydration, and shock. Assess abdomen for increased pain, distention, rigidity, and rebound tenderness because these may indicate postoperative complications. Evaluate dressing and incision. Evaluate the passing of flatus or feces.

 Monitor for nausea and vomiting. Laboratory values are monitored and patient is evaluated for sign and symptoms of electrolyte imbalances. Wound drains, I.V, and all other catheter are monitored and evaluated for signs of infections. Turning , coughing, deep breathing, and incentive spirometry are performed every 2 hours. Diet is advanced as ordered. Administration of medications as ordered Patient Education and Health Maintenance Instruct patient to avoid heavy lifting for 4 to 6 weeks after surgery. Instruct patient to report symptoms of anorexia, nausea, vomiting, fever, abdominal pain, incisional redness and drainage postoperatively. Reference:

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Prepared by: Melendres, Mark James Burasca, Janica L.