Appendicectomy-open-child-PatientInformation

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APPENDICECTOMY - OPEN - CHILD

MICHAEL EDWARDS


Author's note

This information describes what a patient may expect when having the described operation.

The information is specific to the author's practice.

Other surgeons will doubtless differ in their preferences.

The script can be down loaded and edited to suit other surgeons.

Click here for the PDF version of the leaflet

You will need Abobe Acrobat Reader which can be downloaded from http://www.adobe.com/uk/products/acrobat/readermain.html


Your Child's Appendix Operation - Some Information

These notes give a guide to your child's stay in hospital. They also give an idea about what it will be like afterwards. They do not cover everything. If you want to know more, please ask.


What is the Appendix?

The appendix is an out-pouching of the bowel about the size of your child's little finger. It lies low down in the right side of his/her 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 (appendicitis). 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 children 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. Appendicitis is not the parents' fault.


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.


Are there any alternatives?

If you leave things as they are, your child will probably get much worse. Your child can become very ill with infection and bowel problems. Antibiotics on their own are not helpful.

There is no x-ray or laser treatment. Taking out your appendix using a keyhole method is not safe for your child.


What happens before the operation?

Welcome to the ward

You child will be welcomed to the ward by the nurses or the receptionist. Your child will have his/her details checked. Your child will be asked to change into nightwear and to get into bed. He/she will have some basic tests done, such as pulse, temperature, blood pressure and urine examination.

You will be asked to hand in any medicines or drugs your child may be taking, so that the drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings.


Visits by the surgical team

Your child will be seen by the children's doctor and the House Surgeon, who will examine him/her. The operation will be explained to you. You will be asked to sign your consent for the operation. If you are not clear about any part of the operation, ask for more details from the doctors or from the nurses. They are never too busy to do this. We will mark the operation site on the skin with a skin pencil.

Your child will be seen by the surgeon who will be doing the operation. He will check that all the necessary preparations have been made.


Shaving

Excess hair on the tummy will be shaved off.


Periods

The periods do not affect the operation.


Visits by the anaesthetic team

One or more anaesthetists who will be giving the anaesthetic will interview and examine your child. They will be especially interested in coughs, colds, wheezing, runny noses, dental treatment and any previous anaesthetics. Plus any anaesthetic problems in the family.


Diet

Your child should not have eaten or drunk for 4 hours before the operation. This should prevent vomiting during the operation.


Timing of the operation

The nurses will tell you when your child is due to the operating theatre. Do not be surprised, however, if there are changes to the exact timing.


Premedication

Your child may be given a sedative liquid about 1 hour before the operation.


Transfer to theatre

Your child will be taken on a trolley to the operating suite by a ward nurse and a theatre porter. You can go right to reception area with your child. You will be asked to return to the Childrens Ward. Your child will be given an anaesthetic and will be asleep.


The operation is then performed.


What happens after the operation?

Coming round after the anaesthetic

Although your child will be conscious a minute or two after the operation ends, he/she is unlikely to remember anything for an hour or so. Some children feel a bit sick for up to 24 hours after operation, but this passes off. We will give some treatment for sickness if necessary.

Your child may be given oxygen from a face mask for a few hours if there have been chest problems in the past.

Your child may have a fine plastic tube running down the back of the nose to drain the stomach for a few days. Your child may have a fine tube in an arm vein connected to a plastic bottle to give salt, sugar and water until the bowel recovers from the operation.

There may have a rubber drainage tube coming out of the skin near the wound to get rid of secretions. Your child will have a dressing on the wound.


Warning after a General Anaesthetic

The drugs we give for a general anaesthetic will make your child clumsy, slow and forgetful for about 24 hours. This happens even if he or she feels quite alright but the effect passes off.


Will it hurt?

There is some discomfort on moving rather than severe pain. Your child will be given injections or tablets to control this as required. He/ she should ask for more if the pain is still unpleasant.

Your child will be expected to get out of bed the day after operation despite the discomfort. It will not do the wound any harm, and the exercise is very helpful . The second day after operation your child should be able to spend most of the time out of bed and in reasonable comfort. Your child should be able to walk slowly along the corridor.

By the end of one week the wound should be virtually pain-free.


Drinking and eating

Your child will probably be able to drink a little within 12 hours of the operation. Your child will not have a lot to drink until wind passes down below, which means that the bowel is starting up again.

Your child should build up to a normal diet within 3 or 4 days.


Opening bowels

It is quite normal for the bowels not to open for a day or two after the operation. The bowel usually stops working for a time due to the inflammation of the appendix. We will pay very close attention to your child passing wind down below and opening the bowels. We will give treatment as needed.


Passing urine

It is important that your child passes urine and empties the bladder within 6-12 hours of the operation. If using a bed pan or a bottle are difficult, the nurses will assist your child to a commode or the toilet. If your child still cannot pass urine, the nurses will take steps to correct the problem.


Sleeping

Your child will be offered painkillers rather than sleeping pills to help sleep. If your child cannot sleep despite the painkillers please, the nurses will give other treatment.


The wound and stitches

The wound has a dressing which may show some staining with old blood in the first 24 hours. The dressing will be changed and the wound will be sprayed with a acrylic varnish similar to nail varnish. We can take the dressing off after 48 hours. There is no need for a dressing after this unless the wound is painful when rubbed by clothing. There are no stitches in the skin. The wound is held together underneath the skin and does not need further attention.

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. The acrylic varnish will peel off and can be assisted with nail varnish remover. Occasionally minor matchhead sized blebs form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so. Any wound drain is usually taken out in 3 or 4 days.


Washing

Your child can wash the wound area as soon as the dressing has been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. Your child can shower or take a bath as often as wanted.


How long in hospital?

Usually after 3 to 5 days from the time of operation your child will be fit enough to leave hospital provided there is someone to look after him/her at home. The nurses will talk to you about your home arrangements so that a proper time for your child to leave hospital can be arranged.

You will be given an appointment to visit the Surgical Out Patient Department for a check up about one month after your child leaves hospital.


Sick notes

Please ask the nurses for sick notes, certificates etc


What about informing relatives and contacts?

With your permission, the nurses and doctors will keep relatives and contacts up to date with your child's progress.


After your child leaves hospital

Your child is likely to feel tired and need rests 2 or 3 times a day for 2 weeks or more. Your child will gradually improve so that after a month he/she should be fit enough for normal activities.

At first discomfort in the wound will prevent your child from coming to harm by too heavy lifting. After one month your child can lift whatever he/she wants. There is no value in attempting to speed the recovery of the wound by special exercises before the month is out.


School

Your child should be able to return to school work after about 2 weeks, and any heavy exercise within 4 weeks.


Complications

Complications are sometimes seen mainly because of infection from the appendix. Your child will be given antibiotics to counter this. If you think that all is not well, please ask the nurses or doctors. Bruising and swelling may be troublesome. The swelling make take 4 to 6 weeks to settle down.

Your child's recovery can be slower if the appendix has burst by the time of operation. Occasionally there is a discharge from the wound as infection clears itself. Rarely infection gathers inside the tummy and needs to be drained. Aches and twinges may be felt in the wound for up to 6 months.


General advice

The operation should not be underestimated, but practically all patients are back to normal health within 6 weeks. If you have any problems or queries, please ask the nurses or doctors.


Any Questions?

If you have any questions, jot them down here and ask the doctors or nurses for answers.


Any complaints?

If you have any complaints, please contact the doctors or nurses straight away. If this does not solve the problem, please write to your surgeon


Have you any comments?

We welcome your comments and suggestions covering your child's illness, treatment in hospital, and recovery. Please write below any points you would like to make. If you prefer, you need not give your child's name.


Full name:

Hospital:

Ward:

Date of stay in hospital:

Operation:

Out patients department:

Admission arrangements:

Your child's welcome on the ward:

Nursing staff:

General ward atmosphere:

Medical staff:

Ward orderlies:

Portering staff:

X-ray staff:

ECG staff:

Did you know who was who?:

Bedding:

Food and drink:

Privacy:

Locker space:

Toilets:

Bathrooms:

Other patients:

Noise:

Information:

Telephone/TV/radio/newspapers:

Timing of operation:

Preparations for your child's operation:

Going into the theatre:

In the operating theatre:

In the recovery room:

Coming back from theatre:

Intensive Care ward:

Recovery on the ward:

Pain control:

Sleeping:

Wound dressings:

Stitches, clips:

Progress reports:

Visiting hours:

Rest room:

Tablets, medicines, injections:

Going-home arrangements:

Out-patient follow up:


Anything else?

Continue comments overleaf if you wish.

Please send this questionnaire to your surgeon.