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These notes give an overall guide to your stay in hospital. You may see some differences in the details of your treatment, since it is tailored to suit your own condition.
WHAT IS THE APPENDIX?
The appendix is an outpouching of the bowel about the size of your little finger. It lies low down in the right side of your tummy. It is of no practical use in man, but is important in grass-eating animals. Quite commonly the appendix gets swollen and causes pain. If left it can end up by bursting inside the tummy causing serious infection and illness. Sometimes the appendix scars up from past infections and causes pains (grumbling appendix). A diseased appendix needs to be taken out. Sometimes in patients with symptoms, the appendix is normal when it is taken out. In cases of doubt, it is safer to remove the appendix than to risk the problem of leaving a diseased appendix inside.
What does the operation consist of?
The operation is called appendicectomy. A cut is made in the skin and muscle over the appendix. The appendix is cut off and the hole in the bowel is closed. The wound is then stitched up. If there is doubt about the diagnosis your surgeon may elect to examine the appendix through a small telescope placed into the tummy. This is more likely in females where ovarian problems can mimic appendicitis. This is called a "laparoscopy".
WHAT HAPPENS BEFORE THE OPERATION?
Reception
When registering at reception your medical aid details will be required. If you are not on a member of a medical aid you will be required to pay a deposit or to sign an indemnity form. As far as possible we will try to advise you about hospital costs before your admission.
Welcome to the ward
You will be welcomed to the ward by the nurses or the receptionist and will have your details checked. Some basic tests will be done such as pulse, temperature, blood pressure and urine examination. You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings. The surgeon will have explained the operation and you will be asked to sign your consent for the operation. If you are not clear about any part of the operation, then read this again and then ask for more details from the surgeon or from the nurses.
Visit by the anaesthetist
If you are having a general anaesthetic, the anaesthetist who will be giving your anaesthetic will interview and examine you. He will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had.
Diet
You will have your usual diet until 4-6 hours before the operation when you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during the operation.
Shaving
In an adult the operation area will be shaved to remove excess hair.
Transfer to theatre
You will be taken on a trolley to the operating suite by the staff. You will be wearing a cotton gown, wedding rings will be fastened with tape and removable dentures will be left on the ward. There will be several checks on your details on the way to the operating theatre where your anaesthetic will begin.
The operation is then performed.
WHAT HAPPENS AFTER THE OPERATION?
Coming round after the anaesthetic
Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. Some patients feel a bit sick for up to 24 hours after operation, but this passes off. You will be given some treatment for sickness if necessary.
Will it hurt?
The wound is painful initially but there is discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant.
You will be expected to get out of bed the day after the operation despite the discomfort. You will not do the wound any harm and the exercise is very helpful for you. The third day after operation you should be able to spend most of your time out of bed and in reasonable comfort. By the end of one week the wound should be virtually painfree.
Drinking and eating
The operation causes the bowel to slow down for a day or two. The first signs of returning bowel activity are noises in your tummy and passing wind out of your back passage. Once these have happened you will be able to start eating - a little at a time. You should be eating normally after 2 to 5 days.
Opening bowels
It is quite normal for the bowels not to open for a day or so after operation. Sometimes the motion is runny at first. This nearly always clears up. Ask the doctor if it is troublesome.
Sleeping
You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know.
The wound
The wound has a dressing which may show some staining with blood in the first 24 hours. The wound is held together by stitches which are removed after 8-10 days. The dressing is usually removed after 1-3 days and replaced. This dressing is usually waterproof allowing you to shower. Sometimes a plastic drain is used to drain excessive secretions from the wound or abdominal cavity. It may be slightly uncomfortable but is removed after a few days.
There may be some purple bruising around the wound which spreads downward by gravity and fades to a yellow colour after 2 to 3 days. It is not important. There may be some swelling of the surrounding skin which also improves in 2 to 3 days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor match-head sized blebs form on the wound line but these settle down after discharging a blob of yellow fluid for a day or so.
Washing
You can wash the wound area as soon as the dressing has been removed or earlier with a waterproof dressing. Soap and tap water are entirely adequate. Salted water is not necessary.
How long in hospital?
Usually you will feel fit enough to leave hospital after 1 to 4 days. You will be given an appointment for a check up about a 10 days after your operation.
Sick notes
Please ask your surgeon for any sick notes or certificates that you may require.
After you leave hospital
You are likely to feel a bit tired and need rests 2 or 3 times a day for a week. You can do any exercise which is comfortable.
School or work
You should be able to return to school or work within 1-2 weeks.
Complications
Complications are seldom serious and are well known. If you think that all is not well, please ask the nurses or doctors. Bruising and swelling may be troublesome. The swelling may take 4 to 6 weeks to settle down. Infection in the wound happens occasionally and will be treated appropriately by the surgeon.
Sometimes there is some discharge from the drain by the wound. This stops given time. Aches and twinges may be felt in the wound for up to 3 months. Occasionally there are numb patches in the skin around the wound which get better after 2 to 3 months.
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