Patients
A Guide to Common GI and Endoscopic Conditions
APPENDICECTOMY
The appendix is a small appendage which hangs from the first part of the large bowel
in the right part of your lower abdomen. It is about 12cm long and a little thicker than a
pencil. If this tube becomes plugged and infected, appendicitis can develop. It occurs
at all ages and in both sexes.
Common signs and sypmtoms
• There is usually pain in the abdomen.
• Loss of appetite, nausea and sometimes vomiting is present.
• The pain eventually becomes prominent on the right side of the lower abdomen.
• A fever may be present.
Diagnosis
• A careful history and physical examination is a most important way to make a
correct diagnosis.
• Your doctor may order an X-ray or ultrasound of the abdomen to see whether any
other abnormalities are present.
• The diagnosis can never be made with 100 percent certainty.
• If it is a close call, it is safer to operate than to risk having an infected appendix
rupture.
Treatment
The treatment for appendicitis is an operation to remove the appendix.
OPERATION:
You will be asleep for the operation.
An incision will be made in the right lower part of your abdomen.
Laparoscopic appendectomy is also an option.
ADVANTAGES OF LAPAROSCOPIC APPENDICECTOMY
The results may vary depending upon the type of surgery and your general health. But the most
common advantages of laparoscopic surgery are:
-Less pain after surgery
– shorter time in the hospital
– faster recovery
– Having normal bowel movements sooner
– A smaller scar
Is laparoscopic appendectomy right for you?
Ask your surgeon if a laparoscopic appendectomy is the best option for you. In certain situations, you
might need surgery with one (1) larger incision.
POST-OPERATIVE CARE
• You will be taken to a recovery room. When you are stable you will be taken to
your regular hospital room.
• The pain will be controlled with medicine.
• Your doctor will decide when you may take fluid and food by mouth. This may be
very soon after the operation.
• You should be able to go home in 1 – 3 days depending on how seriously your
appendix was infected. On discharge arrangements will be made by your doctor
for a follow up and removal of the stitches if necessary.
HOME CARE
• You may walk about, even climb stairs but don’t overdo things.
• You will usually be able to eat normally once you have been discharged.
• Your doctor would have discussed the management of your dressings.
• Your incision may be uncomfortable for a few days.
• Your doctor will have discussed with you when you may drive a car.
• Your doctor will discuss with you when you may return to work.
Be sure to call your surgeon or family doctor if you have any of the problems below.
-Fever over 101 degrees F (38.5 C)
-Severe pain or swelling in the belly
-Feeling sick to your stomach or throwing up (nausea or vomiting) – Call your doctor if you cannot eat or
-Blood or pus coming from any of the small cuts in the surgery area – Or redness that spreads or gets
-Pain that your medicines do not help
-Breathing problems or a cough that does not get
Call your doctor’s office if you have any other questions about your recovery
COMPLICATIONS
1. Complications do occasionally occur after an APPENDICECTOMY. It is
important for you to remember that this is a major abdominal operation.
2. An infection of the skin wound frequently occurs.
3. Occasionally an intra-abdominal abscess or even peritonitis occurs after an
appendicectomy. Your doctor will decide whether this necessitates further
surgery.
4. As this is an intra-abdominal operation, intra-abdominal organs may be
damaged. This happens very rarely.
5. An incisional hernia can develop at the site of the appendicectomy incision, this
occasionally occurs especially when there has been a wound infection.
6. Systemic complications like venous thrombosis and pulmonary embolism are
rare but possible after any operation or anaesthetic.
LAPAROSCOPIC CHOLECYSTECTOMY
GENERAL INFORMATION
A cholecystectomy is the removal of the gallbladder which is located under your liver
on the right side of your upper abdomen. The reason for removing the gallbladder is
usually that it contains stones that cause inflammation and symptoms.
Common signs and symptoms
• pain over the gallbladder on the right side of the upper abdomen.
• Often the pain comes on after a heavy meal. It may come and go or be there all
the time.
• The pain may shoot to the back and to the tip of the right shoulder blade.
• There is loss of appetite or nausea. Sometimes there is vomiting which may have
a bitter taste.
• There may be fever and chills.
• There is tenderness over the gallbladder. This may be mild or it may be very
severe.
• A fullness may be felt over the gallbladder area.
You are more likely to get gallstones if you:- Are a woman,
-Have had children
-Are overweight, or
-Are over 40.
You might also get gallstones if other people in your family had them. Doctors do not have a consistent
way of preventing gallstones.
Diagnosis
• Can sometimes be made clinically.
• An X-ray of the abdomen may show gallstones.
• An ultrasound may show the disease of the gallbladder.
Treatment
The best treatment is to remove the gallbladder.
Until a few years ago most gallbladders were removed through an abdominal incision.
These days most gallbladders can be removed laparoscopically through 3 or more
small incisions. The patient has less pain and a faster recovery. It is important to
remember that at times it may not be safe to do the operation with a laparoscope and
an open cholecystectomy may need to be done. When your doctor converts a
laparoscopic cholecystectomy to an open cholecystectomy, this is not considered a
complication, this is considered to be good surgical practice.
It is important to remember that a cholecystectomy remains a major operation, even
when doing it with the laparoscope. This however makes it easier for you. Do not think
it is a minor operation.
PRE-OPERATIVE PREPARATION
The best treatment is to remove the gallbladder.
Until a few years ago most gallbladders were removed through an abdominal incision.
These days most gallbladders can be removed laparoscopically through 3 or more
small incisions. The patient has less pain and a faster recovery. It is important to
remember that at times it may not be safe to do the operation with a laparoscope and
an open cholecystectomy may need to be done. When your doctor converts a
laparoscopic cholecystectomy to an open cholecystectomy, this is not considered a
complication, this is considered to be good surgical practice.
It is important to remember that a cholecystectomy remains a major operation, even
when doing it with the laparoscope. This however makes it easier for you. Do not think
it is a minor operation.
OPERATION
• The operation will be done under general anaesthetic. Three or more small
incisions will be used through each of which cannulae are inserted.
• The operation usually takes one hour or longer.
• Usually the whole gallbladder with all the stones it contains is removed.
Advantages of laparoscopic gallbladder surgery
Smaller incision – Several small incisions, each less than one (1) inch long, instead of a 5- to 7-inch
incision for open surgery.
Less pain than after open surgery.
Quicker recovery than open surgery – You might go home the same day you have your surgery. You can
also go back to regular activities more quickly.
What if I Cannot Have Laparoscopic Gallbladder Removal?
A few people cannot have laparoscopic gallbladder removal. You might have open surgery if you are one
of these people. Some reasons for having or switching to open surgery are:
Your gallbladder has a lot of damage – Such as scars or inflammation.
You have scar tissue in your abdomen from earlier surgery.
You have obesity – This means being very overweight.
The surgeon cannot see very well inside your body through the laparoscope.
You have bleeding problems during surgery.
It is not a complication (problem) if your surgeon decides to switch to open surgery. They will switch if
open surgery is the safest option for you. Your surgeon might not know this until after the laparoscopy
starts. They will use their best judgment about the safest surgery for you.
POST OPERATIVE CARE
• After the operation you will be taken to a recovery room. When you are stable you
will be taken to your regular hospital bed.
• Any pain, discomfort, or nausea will be controlled with medication.
• If the operation has been completed with a laparoscope you can expect to be
discharged a day or two after the operation.
Be sure to call your surgeon or family doctor if you have any of problems below.
-Fever over 101 degrees F (38.5 C)
-Severe pain or swelling in the belly
-Yellow skin (jaundice)
-Feeling sick to your stomach or throwing up (nausea or vomiting) – Call your doctor if you cannot eat or
drink.
-Blood or pus coming from any of the small cuts in the surgery area – Or redness that spreads or gets
worse.
-Pain that your medicines do not help
-Breathing problems or a cough that does not get better.
COMPLICATIONS
1. Complications are infrequent after a LAPAROSCOPIC CHOLECYSTECTOMY. It
is however important for you to remember that it is a major abdominal operation
and complications may occur.
2. A bleed or an infection is always possible at the site of the small incisions.
3. Very occasionally a small incisional hernia can develop at a port site.
4. Occasionally a collection of bile develops in the peritoneal cavity. This can delay
your recovery. If you are not recovering fairly promptly after the operation your
doctor may decide to do an ultrasound. A collection of bile can mostly be drained
by needle or catheter without the need for an operation. Very rarely is a further
laparoscopic or open operation necessary.
5. There is a 0.5% incidence of damage to the bile ducts in the vicinity of the
gallbladder. When this occurs further surgery will be necessary.
6. Also remember that as this is an intra-abdominal operation it is possible for intra-abdominal organs to
be injured during the operation.
7. Systemic complications like venous thrombosis and pulmonary embolism are rare,
but possible after any operation or anaesthetic.
Activities
You should be as active as your body allows. Doctors recommend walking. You can go up and down
stairs on the day of your surgery. The next day, you may take your bandages off, if you have them, and
take a shower. You can expect to feel a little better each day after going home. If not, please call your
doctor.
If you had an open surgery with a large incision, you need more time to recover. You will probably need
to stay in the hospital for a few days after surgery. Expect to go back to full activities in 4 to 6 weeks. You
will probably recover more slowly in other ways, too. Your doctor can tell you what to expect.
When to see your doctor after surgery
You need to see your surgeon 2 to 3 weeks after surgery