What should I expect from laparoscopic appendectomy on a previously ruptured appendix?
August 31, 2011 1:52 PM   Subscribe

Laparoscopic appendectomy on a previously ruptured appendix?

I am having laparoscopic appendectomy in 7 days from today. It sounds weird, so I'll give you a bit of back story.

About 1.5 months ago, while being on a vacation; I woke up one day and didn't feel great, almost like coming down with a cold, some stomachache... I assumed I was getting stomach flu since 3 of the people I was spending time with had gotten sick a couple of days earlier after all of us attending a family gathering. I wasn't going to let some flu (I was 100% sure it had to be that, even though I NEVER had gastroenteritis before) ruin my short but needed vacation, so I went on with my day, went bike riding for 20 miles, city walking, shopping...by the end of the day I was in a lot of pain and extremely nauseated. Barely made it back to my relatives' house, at this time running a very high fever, throwing up, diarrhea, dizziness and extreme abdominal pain. I barely slept and woke up not feeling any better but worse.

Again, I was thinking this must be "stomach flu" and never having had that experience, I decided I didn't need to see a doctor. I don't have insurance and I was in a different state and city and knowing that a viral infection has to go away on its own, I decided to ride it out. But I had a 9 hour train ride back home the next day, so I ended up going to see a doctor who told me I needed to go to the ER. Instead, I just took the train back home, insisting it had to be a virus.

Forward 10 days of this same scenario, still vomiting, still having high fevers, pain, diarrhea...all while working normal hours, walking up and down 4 flights of stairs several times a day, riding a bike and not eating almost anything...by the 10th day of this, I could barely walk.

So we go to the ER. The doctor is almost sure is something else, even though the symptoms are all appendicitis. Couldn't be, he said, because too many days have passed. CT scan shows a ruptured appendix, infection, an abscess (that weird enough is what saved my life to that point).

Spent the next 2 weeks in the hospital on strong antibiotics and pain medication and 2 more weeks after that on these antibiotics at home, the surgeon decided the appendix was staying in until the infection was cleared and ONLY THEN surgery could be done.

I have never had major surgery like this, I do not know what to expect and I worry that laparoscopic may not be appropriate although the surgeon says it is. He is a reputable, known surgeon in this field; I should trust him. I know Lap surgery is quicker, less painful, less complications, less scarring; but that is when done on appendices that haven't ruptured, I can't find a whole lot of information on this and what I found doesn't sound good.

Other of my concerns is surgery in general. Has anyone had a laparoscopic appendectomy? How did you feel afterward? Did your diet had to change? How long did it take to do more strenuous physical activities (i.e. cycling)?

Thank you so much for any answers or advice in this subject!
posted by ratita to Health & Fitness (14 answers total)
I know you are fearful, but your track record on being your own doctor is anything but stellar. I say it is time to trust the experts on this one.
posted by thebrokedown at 1:57 PM on August 31, 2011 [4 favorites]

A lap is totally appropriate for this. Virtually anyone who's had an appendectomy in the last whatever number of years has had lap surgery. My ruptured appendix was removed via a lap.

The recovery is so much faster. I had no food restrictions after I was released, was walking hunched over 3 days later, was walking the dog hunched over 4 days later, and was fine for all activity within a couple of weeks. a lot of how active you feel like being has to do with how fast your incision heals.
posted by DarlingBri at 2:06 PM on August 31, 2011 [2 favorites]

You need to have this surgery. These people know what they are talking about. Also, this type of surgery (laparoscopic) is cake. I had my gall bladder taken out this way about a year ago on a Tuesday morning and was back to work the following Monday.

> Couldn't be, he said, because too many days have passed.

And in saying this was he implying that it couldn't be because others may have died after waiting this long?
posted by dgeiser13 at 2:06 PM on August 31, 2011

I admit I failed miserably at seeing this one coming. But in my defense, I am a 31 yo, healthy woman who hasn't had anything like this before. I am tough and obviously have some pain tolerance. Everyone around me was sick and to make things worse, they too, said that they had horrible abdominal pain, their symptoms were pretty much the same as mine. What was I supposed to think? I don't have insurance, my job doesn't offer one single benefit and I don't make a lot. I wish I was in a different situation at the moment, but that's what it was, I didn't want to walk into the ER and have a 2k bill for something like stomach flu. Unfortunately I "make too much" to qualify for any assistance, although in reality I really don't make that much.

It is my first surgery. I don't know what to expect. I'd like some recommendations/advice in recovery from anyone who has had this type of procedure before, diets that helped them recover, exercises, etc.
posted by ratita at 2:10 PM on August 31, 2011

Couldn't be, he said, because too many days have passed.

And in saying this was he implying that it couldn't be because others may have died after waiting this long?

Yes. :(
posted by ratita at 2:11 PM on August 31, 2011

I worry that laparoscopic may not be appropriate although the surgeon says it is.

Speak with the doctor or staff, but the typical route is that if they get in there and the surgery can't be done via scope it will be done open. You really would prefer the laparoscopic.

Otherwise, it's a fairly standard procedure. Recovery time is a few days to get back to functional and a couple of weeks to be 100%. The open appendectomy will be a few extra days to be functional and a few extra weeks to be 100%. Odds are you will start feeling much better as soon as it's out; this is one of the awesomely weird things about appendectomies.
posted by Mister Fabulous at 2:15 PM on August 31, 2011

Has anyone had a laparoscopic appendectomy?

Yes! I simultaneously had appendicitis, which had in my case felt like getting stabbed several times a day, and problems with ovarian cysts. When I went to the ER in tremendous pain late one night, an intern poked at my abdomen until he ruptured a cyst, initiating internal hemorrhaging. Emergency surgery time!

How did you feel afterward?

So, so, so much better, I can't even tell you. They give you good drugs to take care of the pain--which is absolutely nothing compared to being sick beforehand. I remember feeling like I was cleaner afterwards. I know that sounds weird, and maybe I'm completely wrong, but I attribute it to a lot of the bacteria being gone that were making me feel awful and draggy.

Did your diet had to change?

Not at all.

How long did it take to do more strenuous physical activities (i.e. cycling)?

I was never really into that, so I can't say. In summary, I concur with other posters that laparoscopic surgery is totally, totally cake. I had another one several years later, also no problem.
posted by heatvision at 2:16 PM on August 31, 2011 [1 favorite]

Thank you for your answers! :)
I am not in the best shape of my life anymore, but I am quite active, I bike to work (well, not since all this started as it is 2 miles up a steep hill) I cycle most of the week, I walk, I run and I swim. Although this issue in the past couple of months have slowed all that. I am in the dreaded 10-15 lbs over what I should weight which bothers me much. All I hope is that I can get back to normal soon after the surgery, to start exercising again, and most importantly because I had a very special 150 mile bike ride and a 5k planned in October 15th and would hate to miss it, this was going to be a huge personal challenge.

The diet question comes because while I was in the hospital I was given a low-fat, very low-carb, high protein diet to follow until surgery, that's what I have been doing ever since. The sugars from carbs can promote bacterial growth and the fats are not easy to digest. The doctor told me I could eat what I wanted and craved on occasion too, since it took a couple of weeks to get any appetite back after taking the antibiotics and lost about 15 lbs while hospitalized (yay?). I have tried to just stick to this diet and not take chances. On the times I have eaten "bad" (pizza, pasta, breads) I have felt awful, achy, bloated. I love rice and that's one of the things I really have to limit myself with. I'd love to eat some indian food soon!
posted by ratita at 2:35 PM on August 31, 2011

One thing that people don't always expect after laproscopic surgery is that their shoulders hurt. The reason why is that they fill your abdomen with air (maybe carbon dioxide?) to kind of "inflate" everything and give them room to work and see what they are doing. Not all of the air actually comes back out of the lap incisions, and for some reason it heads north and winds up making your shoulders hurt. My sister had this when her gallbladder was taken out and she thought she had somehow strained her shoulder while in the hospital. Turns out it was the air being "outgassed" (or whatever the term is for it). So don't freak out if your shoulders hurt...ask the nurses about it to be sure. Sister didn't have to do anything special about it, but I think moving around helped work it all out.
posted by MultiFaceted at 4:39 PM on August 31, 2011

I had a laproscopic appendectomy 6 years ago, at age 20. I am/was also a very active female.

Right after the surgery, I spent 1.5 days in the hospital. Then I spent 2-3 days in a hotel room (since i was living in a dorm) with my mom taking care of me.

It took me about a month to get back to my normal active self, but most pain completely stopped 2.5ish weeks after the surgery.

I had zero diet restrictions, but my appendix didn't burst.
posted by nanhey at 5:27 PM on August 31, 2011

My husband and a good friend both just went through procedures like this. Here's how it went with my husband, whose appendix was also removed after it ruptured and resealed:

On the day of the surgery we met with the surgeon and anethesiologist, one at a time. They each explained their roles in the procedure, the risks involved, and made sure that he consented to the surgery. He may have had to sign some paperwork. He was allowed to ask questions, and the doctors took each question (even joking ones) very seriously and answered each at length.

Then I was asked to leave while he was put under.

While unconscious, he received four incisions - one just below his belly button, one a few inches lower in the pubic hair region, and two slanting ones on either side. His belly was inflated with air to make room for the surgery bots move around and do the work, and the appendix was removed through the belly button incision. He was then glued, not stitched, back together, with surgical glue that dissolves on his own, and then woken up. He was pretty dopy and confused for the first 2-4 hours because of the anesthesia and the pain meds.

Even though laproscopic surgery is a lot easier on your body than full-on surgery, even small abdominal incisions are tough. You'll probably hurt a lot when you wake up. In both my husband's case and my friend's, they were told they'd probably leave the day of the surgery, but they both were still hurting enough that they were kept overnight until their pain was under control. When you stay overnight you can get faster-acting painkillers administered by IV, and you can find out what works for you. Codeine and vicodin did nothing for my husband, but ibuprofin made everything better. Only vicodin worked for my friend. Everybody is different.

Because they pump air into your belly and are poking around near your intestines, there's a small chance that your digestive system will be a bit disturbed by the process. Generally, they don't let you leave the hospital until you successfully shit and/or fart, just to be safe. My husband's intestinal tract was bumped during his appendectomy, which resulted in an ileus - a temporary halt in digestive tract movement that's not caused by a blockage. Even if your digestive system is disturbed like this, it will kick back in with time. Making sure you get up and walk around as you recover, even though it is uncomfortable, will go a long way towards getting things moving again.

In terms of recovery: Neither my husband nor my friend had to change their diets. My friend's not much of an exerciser, but my husband put high-impact athletic endeavors on hold for about a month. That meant no jogging or basketball matches, but he was walking the half mile to work and half mile back within a week. After a month or a little bit less he was back to normal.

The hardest thing for me in each instance, as a supportive friend/partner, was understanding how the hospital system worked, what was supposed to happen, who I was talking to, what that person's role was, and who to talk to for each type of question and concern we had -- though I suspect you already learned a lot about this during your two weeks in the hospital.
posted by croutonsupafreak at 5:30 PM on August 31, 2011

I had a very special 150 mile bike ride and a 5k planned in October 15th

That's only six weeks from now, make sure you mention this to the doctors when you talk about recovery. Given your condition before the surgery, and the impact of the surgery, that might not be a safe goal for you.

I had my gallbladder removed laproscopically about seven or eight years ago and I while felt well enough to get back to my activities with a week or so, I definitely felt the surgery for weeks afterward.
posted by crankylex at 6:01 PM on August 31, 2011

I had something similar, where I had appendicitis that went undiagnosed for a couple of months even though I saw a doctor. They were thrown off by the fact that I didn't have pain in the usual location. The symptom was actually that the infection had spread to my liver, which resulted in an abscess (but no rupture). This is what was causing me pain.

Anyways, I ended up getting emergency surgery after another (more competent) doctor looked at me and noticed on an ultrasound that I had appendicitis. It went so quickly that I didn't know what they were going to do beforehand, but the surgeon took the time afterwards to explain it to me.

For me, they went in laparoscopically, but the doctor decided after getting a good look at my appendix that it would be better to do it traditionally. So in addition to the small cuts described above, he cut me open (4-5 inches?) on the bottom right of my torso, and took it out the good old fashioned way.

TL;DR: Trust your doctor. If he/she notices that it's not going to work with laparoscopic surgery, they can always change their mind during the procedure.
posted by Simon Barclay at 6:20 PM on August 31, 2011

I just wanted to chime in and say that recovery from "traditional" appendectomy surgery isn't terrible either. I had my appendix out at 10 (20*mumble* years ago), had a two inch incision next to my right hip crest that didn't cut abdominal muscle and I was up walking the next day. I'm pretty sure I was prohibited from strenuous activity for a week or two afterwards, but I was back in school in less than a week. Walking was the best cure.
posted by blueskiesinside at 11:33 PM on August 31, 2011

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