Appendix

Appendix is a vestigial organ in human being, attached to right colon.

The appendix produces a bacteria destroying protein called immunoglobulins which help fight infection in the body. Its function, however, is not essential. People who have had appendectomies do not have an increased risk toward infection. Other organs in the body take over this function once the appendix has been removed.

Appendicitis ( infection of appendix) occurs when the appendix becomes blocked, often by stool or as a result of infection in body, since the appendix swells in response to any infection in the body. In elderly person, it may be blocked by tumor, thus requiring proper evaluation before going for surgery.

Pain around naval that later moves to the lower right abdomen. This is usually the first sign. This may be associated with nausea and/or vomiting and fever.

Appendicitis is usually diagnosed by clinical & rectal examination and supported with blood, urine and USG/CT scan.

The treatment for appendicitis usually is antibiotics and appendectomy (surgery to remove the appendix).

If appendicitis is even suspected, its better to err on the side of safety and quickly remove the appendix to avoid its rupture. If the appendix has formed an abscess, it may need two procedures: one to drain the abscess of pus and fluid, and a later one to remove the appendix.

A cannula (hollow tube) is placed into the abdomen and abdomen will be inflated with carbon dioxide gas to create a space to operate. A laparoscope (a tiny telescope connected to a video camera) is put through one of the cannula which projects a video picture of the internal organs and appendix on a television monitor. Three cannulas are placed in different locations on your abdomen to allow surgeon to place instruments inside your belly to work and remove your appendix. After appendix is cut from all that it is connected to, it is placed inside a special bag & is pulled up into one of the incision and taken out.

Common advantages of laparoscopic appendectomy are: Less postoperative pain, shorten hospital stay, quicker return to bowel function, quicker return to normal activity & better cosmetic results

Our health care team members shall help you to prepare for surgery.

Pre-operative testing

in most cases, you will need some tests before your surgery. The tests routinely used include:

•   Blood tests to measure your blood counts, your risk of bleeding or infection.
•   Chest x-ray and ECG (electrocardiogram) to check your lungs and your hearts electrical system.

Anaesthetic Assessment before Surgery:

Our expert team of Anaesthetist will ask you questions pertaining to your health and to assess your fitness for surgery. You are requested to tell them in detail about your current and past medical ailments, allergic reactions you’ve had in the past and current medicines that you are taking like blood thinning medicine. This medicine should be stopped prior to surgery to minimize the risk of bleeding during /after surgery.

Informed Consent

Informed consent is one of the most important parts of “getting ready for surgery. It is a process during which you are told about all aspects of the treatment before you give written permission to perform the surgery.

Getting ready for Surgery

Depending on the type of operation you have, there may be things you need to do to be ready for surgery:

•   Emptying your stomach and bowels (digestive tract) is important. Vomiting while under anaesthesia can be very dangerous because the vomitus could get into your lungs and cause an infection. Because of this, you will be asked to not eat or drink anything starting the night before the surgery or atleast 6 hours before surgery.
•   Shaving of Operative part: You need to have an area of your body shaved to keep hair from getting into the surgical cut (incision). The area will be cleaned before the operation to reduce the risk of infection.

Anaesthesia is the use of drugs to make the body unable to feel pain for a period of time. General anaesthesia puts you into a deep sleep for the surgery. It is often started by having you breathe into a face mask or by putting a drug into a vein in your arm. Once you are asleep, an endotracheal or ET tube is put in your throat to make it easy for you to breathe. Your heart rate, breathing rate, and blood pressure (vital signs) will be closely watched during the surgery. A doctor watches you throughout the procedure and until you wake up. They also take out the ET tube when the operation is over. You will be taken to the recovery room to be watched closely while the effects of the drugs wear off. This may take hours. People waking up from general anaesthesia often feel "out of it" for some time. Things may seem hazy or dream-like for a while. Your throat may be sore for a while from the endotracheal (ET) tube.

Pain

You may feel pain at the site of surgery. We aim to keep you pain free after surgery with the help of latest and most effective technique or analgesic (pain relieving medicine).

Eating and Drinking

You will be allowed orally liquids once you recover from effect of anaesthesia medicine and you don't have nausea or vomiting. Gradually you can add soft to normal diet.

Activity

Our health care team will try to have you move around as soon as possible after surgery. You are encouraged to get out of bed and walk the same day. While this may be hard at first, it helps speed your recovery. It also helps your circulation and helps prevent blood clots from forming in your legs.

Going home

Once you are eating and walking, and then you are ready to go home, in most case in next day following surgery. Before leaving for home our health care team shall give you detailed guidance regarding diet, activities, medications & further plan of treatment

There are risks that go with any type of medical procedure and surgery is no longer an exception. Success of surgery depends upon 3 factors: type of disease/surgery, experience of surgeon and overall health of patients. What's important is whether the expected benefits outweigh the possible risks.

Complications in major surgical procedures include:

Complications related to Anaesthesia:Reactions to drugs used (anesthesia) or other medicines. Although rare, these can be serious because they can cause dangerously low blood pressures.

Complications related to underlying medical illness like heart disease, diabetes, kidney disease, obesity, malnutrition.

Complications related to Specific Operations:

•   A leak at the edge of the colon where the appendix was removed
•   Injury to adjacent organs such as the small intestine, ureter, or bladder.
•   Bleeding, infection etc
•   You are encouraged with discuss in detail with our health care team before you give your consent for surgery.

Conversion to open surgery: In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs (appendix) effectively. Factors that may increase the possibility of converting to the “open” procedure may include perforated & densely adherent appendix to nearby organ, obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation. The decision to convert to an open procedure is strictly based on patient safety.

Side effect of Surgery: As appendix is vestigial organ in human body, i.e it does not serve any important function in body so its removal do not affect human body.

Our health care team shall advise you in detail regarding dietary habits, Briefly, your diet begins with liquids followed by gradual advance to solid foods.

Patients are encouraged to engage in light activity while at home. You will be able to get back to your normal activities within a short amount of time (week).

You may be advised to see our health care team after 1 week to assess your progress and to address your problems.