APPENDECTOMY

AND

HEMORRHOIDECTOMY
Arianna Mabunga
Appendectomy
 WHAT IS THE APENDICITIS
The appendix is a small, pouch-like sac of tissue
at the accending colon. It can be found in an area
in the lower-right quadrant of the abdomen .
The appendix plays an important role in boosting
the immune system. This harbors gut bacteria and
helps the digestive system recover after an
infection.
Appendicitis is inflammation of the appendix.
Appendicitis can occur when mucus, stool, a
growth, or a combination of these blocks the
opening of the appendix.
If the inflammation and blockage are severe enough,
the tissue of the appendix may rupture. The risk of a
ruptured appendix becomes greater the longer
treatment is delayed for appendicitis.
An appendectomy is surgery to remove the
appendix when it is infected, this condition is
called appendicitis
WHAT IS AN
APPENDECTOMY?
Appendectomy is a common emergency surgery.

There are 2 types of surgery to remove the

appendix. The standard method is an open
appendectomy. A newer, less invasive method is
a laparoscopic appendectomy.
 WHAT HAPPENS...

BEFORE DURING AFTER

THE SURGERY

Pre-operative
Care
Make sure the patient or the legal companion is
informed about the procedure/ surgery she/he will
be undergoing
Make sure the patient or the legal companion had
signed the necessary documents prior to surgery.
Eg. Informed Consent
It is important to know the medications the
patient is taking (if there are any) check for high
alert meds.
Take note of the patient's allergy history prior to surgery.
Make sure the patient in on NPO Bowel preparation for
surgery
Check the patient's pre-operative lab works and
notify the Surgeon for any abnormalities.
Check for any special order by the Surgeon
Monitor the patient's vital signs every 30 mins
Make sure the patient has no valuables on her body,
make up, eye glasses, nail polish, dentures and hearing
aids are removed.
Prepare the patient's skin/site of incision with anti-
microbial soap
Make sure to administer and chart pre-operative
medications as ordered by the physician.
Allow the patient to void prior to transfer.
WHAT HAPPENS...

DURING

THE SURGERY
 OPEN
APPENDECTOMY
In an Open Appendectomy, a cut or incision about 2
to 4 inches long is made in the lower right-hand side
of your belly or abdomen. The appendix is taken out
through the incision. and the wound is closed with
stiches. This procedure allows the doctor to clean the
abdominal cavity if the appendix has burst.

An open appendectomy is opted if the appendix

has ruptured and the infection has spread to other
organs. It’s also the preferred option for people
who have had abdominal surgery in the past.
Contraindications Open Appendectomy is
contraindicated for patients
with beleeding disorders
COMPLICATIONS Bleeding.
Wound infection.
Infection and swelling
Blocked bowels.
Injury to nearby organs.
 LAPAROSCOPIC
APPENDECTOMY
It’s done without a large incision. Instead, from 1 to 3 tiny
cuts are made. A long, thin tube called a laparoscope is
put into one of the incisions. It has a tiny video camera
and surgical tools. The surgeon looks at a TV monitor to
see inside your abdomen and guide the tools. The
appendix is removed through one of the incisions. The
small incisions are then cleaned, closed, and dressed.

Laparoscopic surgery is usually the best option for older

adults and people who are overweight. It has fewer risks
than an open appendectomy procedure, and generally
has a shorter recovery time.
 Laparoscopic Appendectomy
is contraindicated for
patients with ..
Contraindications
Extensive Adhesions,
Radiation Therapy
Immunosuppressive Therapy,
Severe Portal Hypertension,
Coagulopathies
Pregnancy
COMPLICATIONS
Bleeding.
Wound infection.
Hernias,
Blood clots,
Abscess
WHAT HAPPENS...

AFTER

THE SURGERY

Post- operative
Care
In the PACU; the vital signs are monitored every
15 minutes
Once the patient is awake and transported in the
ward the vital signs are monitored every 30 mins,
if the VS are stable it will be monitored every 2
hours then every four hours.
It is also important to monitor the patient for
flatulence before they are cleared to intake any thing
If a drain is inserted in the incision, it is checked every
24 hours and can be removed if there are minimal
drainage 50ml or less.
Monitor the patient's pain using the numerical raiting
pain scale frequently.
Educate and assist the patient in aseptic wound
dressing to avoid any surgical infections.
Administer post-operative medications as ordered.
Educate the patient about the importance continuity
of taking post-operative medications.
Assist and encourage the patient in early post-
operative ambulation
MEDICATIONS Ibuprofen
(Advil)

Antibiotic
(Ceftriaxone)
Hemorrhoidectomy
 Hemorrhoids are swollen veins in the lowest part

WHAT ARE of the rectum and anus. Sometimes, the walls of

these blood vessels stretch so thin that the veins

HEMORRHOIDS? bulge and get irritated, especially when feces

pass

Internal hemorrhoids are usually painless, but tend

to bleed

External hemorrhoids may cause pain.

Hemorrhoids are one of the most common causes

of rectal bleeding.
 Hemorrhoidectomy is a simple surgery
done to remove hemorrhoids.
WHAT IS
Hemorrhoidectomy is appropriate when you have:
HEMORRHOIDECTOMY
Very large internal hemorrhoids.

Internal hemorrhoids that still cause symptoms after

nonsurgical treatment.

Large external hemorrhoids that cause significant

discomfort and make it difficult to keep the anal area
clean.

Both internal and external hemorrhoids.

Had other treatments for hemorrhoids (such as rubber
band ligation) that have failed.
 WHAT HAPPENS...

BEFORE DURING AFTER

THE SURGERY

Pre-operative
Care
Make sure the patient or the legal companion is
informed about the procedure/ surgery she/he will
be undergoing
Make sure the patient or the legal companion had
signed the necessary documents prior to surgery.
Eg. Informed Consent
It is important to know the medications the
patient is taking (if there are any) check for high
alert meds.
Take note of the patient's allergy history prior to surgery.
Make sure the patient in on NPO Bowel preparation for
surgery
Check the patient's pre-operative lab works and
notify the Surgeon for any abnormalities.
Check for any special order by the Surgeon
Monitor the patient's vital signs every 30 mins
Make sure the patient has no valuables on her body,
make up, eye glasses, nail polish, dentures and hearing
aids are removed.
Prepare the patient's skin/site of incision with anti-
microbial soap
Make sure to administer and chart pre-operative
medications as ordered by the physician.
Allow the patient to void prior to transfer.
WHAT HAPPENS...

DURING

THE SURGERY
 TRADITIONAL HEMORRHOIDECTOMY
The patient will be given general anesthesia or spinal
anesthesia. Incisions are made in the tissue around
the hemorrhoid. Surgery can be done with a knife
(scalpel), a tool that uses electricity (cautery pencil),
or a laser. The swollen vein inside the hemorrhoid is
tied off to prevent bleeding, and the hemorrhoid is
removed. The surgical area may be sewn closed or
left open. Medicated gauze covers the wound.
 STAPLED HEMORRHOIDOPEXY.
This procedure uses a circular stapling device to remove
hemorrhoidal tissue and close the wound. No incision is
made. In this procedure, the hemorrhoid is lifted and then
"stapled" back into place in the anal canal. People who
have stapled surgery may have less pain after surgery
than people who have the traditional hemorrhoid surgery.

The stapled surgery is more expensive. And people who

have stapled surgery are more likely to have hemorrhoids
come back and need surgery again.
DOPPLER-GUIDED HEMORRHOIDECTOMY

This procedure uses a scope with a

special probe to locate the
hemorrhoidal arteries so that less
tissue is removed. Some studies
show that it is less painful but
more long term studies are needed
to compare it with other procedure
 It is contraindicated for
patients with ..
Contraindications
Significant medical comorbidities
of Fecal incontinence
Hemorrhoidectomy Rectoceles
Bleeding disorders
Portal hypertension with rectal
varices
Crohn disease
 Pain,
COMPLICATIONS Delayed bleeding,
Urinary retention/urinary tract
infection,
Fecal impaction, and very rarely,
infection,
Wound breakdown,
Fecal incontinence, and
Anal stricture
WHAT HAPPENS...

AFTER

THE SURGERY

Post- operative
Care
In the PACU; the vital signs are monitored every
15 minutes
Once the patient is awake and transported in the
ward the vital signs are monitored every 30 mins,
if the VS are stable it will be monitored every 2
hours then every four hours.
It is also important to monitor the patient for
flatulence before they are cleared to intake any thing
Monitor for bleeding. Some bleeding is normal,
especially with the first bowel movement after
surgery.
Administer hot sitz bath to help relieve pain and
muscle spasms.
Instruct the patient to gradually increase the amount
of fiber in your diet.
Administer and Educate the patient to apply numbing
medicines before and after bowel movements to relieve
pain.
Educate the patient about the importance continuity
of taking post-operative medications.
Instruct the patient to avoid straining during bowel
movements as it can cause hemorrhoids to come back.
 Antibiotic
(Metronidazole
Cream)
MEDICATIONS

Stool Softeners
(Dulcolax)

Ibuprofen Hemorrhoid Cream

(Advil) (Hydrocortisone
cream)
References: Alberta. (2020). Hemorrhoidectomy: What to expect at home. MyHealth.
https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?
hwid=ud1119

Johns Hopkins Medicine. (2020). Appendectomy. Johns Hopkins Medicine, based

in Baltimore, Maryland. https://www.hopkinsmedicine.org/health/treatment-tests-
and-therapies/appendectomy

University of Michigan. (2020). Hemorrhoidectomy for hemorrhoids. Michigan

Medicine. https://www.uofmhealth.org/health-library/hw212391