Appendectomy - Ramsey Stone, M.D.

After your appendectomy:

Your incisions will have stitches that dissolve on the inside and a medical superglue on the outside. Briefly, you don’t have to do anything. Nothing to take care of; nothing to dress or care for. You may shower the next day. No bath/swimming pool for at least a week.

It helps to ice the areas of the incisions for at least the first day or two. Apply ice for 15 minutes at a time every couple of hours while awake (do not apply ice directly on skin).

Some pain is obviously expected. You will be sent home with a prescription for pain medication. The usual pain medication is Norco which is a hydrocodone and Tylenol mixture. Most people who have an allergy to codeine are able to take this without issues. You may also transition to advil, motrin, aleve, or Tylenol. Please do NOT take Tylenol with the Norco as this will lead to too much Tylenol as Norco has this in it.

You will likely hurt most at the largest incision which is usually low in the middle or on the left side. It is also likely that this larger incision will swell (feel like there is a bump or knot underneath it) and bruise. This is all perfectly normal. It is also very normal for your pain to mostly go away, but when you move a certain way/cough/sneeze for you to experience a sharp pain at this bigger incision site.

Nausea and occasionally vomiting is not uncommon for the first 24 hours. This is usually due to the medicines to put you to sleep as well as the surgery itself. Occasionally nausea can persist for a few days. During this time you should try to drink as much liquids as possible to keep from getting dehydrated. Nausea medication is typically prescribed and can be taken as needed.

for the most part, you will be able to go back to a normal diet. There are no restrictions (although low-fat diet is generally recommended). At first try small portions and if you tolerate it, you can increase intake. Sometimes it takes a little while for your GI system to readjust. At first, the main goal is to stay hydrated so make sure to be taking plenty of liquids.

Typically patients are able to return to work after about a week. Please remember that your energy level will lag behind how you feel. Some need to take an additional week or two of light duty/part time. When you get more tired than usual in the afternoon, this is normal!

some abdominal distention is normal. This should improve with time. Make sure that you are not becoming constipated (which happens with the pain medications). Swelling at the incision sites is normal and you may even feel a lump under the incisions. This is normal and will occasionally take a few months to completely go away

Whether you take a few or a whole bunch, pain medicine tends to lead to constipation. My recommendation is to at least take a stool softener while taking pain medicine. I recommend Colace twice a day. This is over the counter but I will likely give you a prescription along with the pain medication prescription. Sometimes even this is not enough, though. Do not let it go for more than a few days without a bowel movement – it only gets harder! I recommend over-the-counter laxatives if you have not had a bowel movement after a few days (a few days is 2 or 3 days, not a week!). I usually recommend miralax at this point. Dulcolax and some of the other over-the-counter laxatives are also good. If you find this not working, usually an enema (fleets enema over the counter) is the next line of therapy. The last line of therapy would be something like magnesium citrate, etc. If you have home remedies or certain foods that work for you, feel free to do this as well.

Please bring these papers by the office for our nursing staff to fill out. You may bring them at the time of follow up visit. Unfortunately, we may not be able to get these back to you the same day.

Please call the office after your surgery and set up a follow-up appointment for 2 weeks after your surgery

Postoperative fever is normal – several days of low-grade fever is normal. This means fever may be normal up to 101 f. The best thing to do for low grade fever is to work your lungs. Your lungs are the most common source for this fever. If you were sent home with a clear breathing machine, work on that several times every hour. If you do not have one of these machines, purchase a balloon (any balloon works) and practice blowing the balloon up several times an hour. The purpose is to expand your lungs (deep breaths) and will help the fever. You may take tylenol for but DO NOT take tylenol with pain medicine that already has tylenol (acetaminophen) in it.

Incisions typically heal with a small amount of pink/red around the incision. Also itching is normal. Bruising (all colors: blue/purple/yellow/green) can also be seen at the incision site or around it. A small amount of clear/reddish fluid drainage can sometimes be seen as well and is usually ok. If the incision site becomes bright red or starts to drain excessively, please contact the office.

In general, the more activity the better. This means walking around and other non-strenuous activity. It is better to hurt a little more and be active than to lay on the couch for a week. Your legs need to help circulate your blood so you don’t get blood clots. They do this best when walking. You will notice that your energy level is not what it was before surgery. This is normal. When you feel tired, it is time to rest. It usually takes longer than you think to get your energy level back. I recommend no heavy lifting (> 15 pounds) for 4 weeks after the surgery.

Some itching is normal. The best treatment for itching is over-the-counter Benadryl. Please be aware that this can cause drowsiness. This is preferable to anti-itch creams but these too may be used if you have no relief with Benadryl (although preferably not directly on the incisions). Occasionally people will develop a rash right around the incision(s). If this happens, you are likely allergic to either the superglue, stitches, or your body reacts this way to incisions. The same treatment as above is recommended. Also, a few people will have a generalized rash that covers just the abdomen. This likely signifies that you are allergic to the cleaning solution used to prep the skin before surgery. Again, the same treatment as above is recommended. For relief, sometimes around the clock Benadryl is needed for several days.

You may drive when you feel that you are able to AND not on pain medication.

Please call the office if you experience:

– fever > 101.5

– pain that is worsening

– redness, increasing swelling, or foul smelling area around the incision(s)

– eyes turning yellow (jaundice)

– any other concerning events