Laparoscopic Appendectomy In Children

WHAT YOU SHOULD KNOW:

• Laparoscopic appendectomy is surgery to treat acute appendicitis. Acute appendicitis is a condition where the appendix becomes inflamed (swollen). The appendix is a small pouch that is attached to the cecum (first part of the large intestine). It is located in the lower right side of the abdomen (stomach). A piece of food or hardened stool may get trapped in the appendix. This may cause the appendix to get blocked, infected, swollen, and filled with pus. If left untreated, the appendix may rupture (burst) and cause severe abdominal pain and infection (peritonitis).
  
  
• In a laparoscopic appendectomy, small incisions (cuts) are made in your child's abdomen (belly). Caregivers will insert special tools and a laparoscope through these incisions to do the surgery. A laparoscope is a long metal tube with a light and tiny video camera on the end. This gives caregivers a clear view of the abdominal area while watching the images on a monitor. During this surgery, your child's appendix will be removed, and the inside of his abdomen cleaned to avoid infection. With a laparoscopic appendectomy, your child's appendicitis may be cured, and the symptoms it causes relieved.

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

RISKS:

• Problems may happen during your child's laparoscopic appendectomy that may lead to a laparotomy (open surgery). His stomach, intestines, blood vessels, or nerves may get injured or burned while having the surgery. He could also have trouble breathing, an infection, or too much bleeding during or after surgery. The special gas used during your child's surgery may be left inside his body and cause vomiting (throwing up). He may also have shoulder or chest pain for 1 to 2 days after his surgery.
  
  
• Without treatment, the appendix may rupture and his symptoms may get worse. If this happens, bowel contents and infected fluid may spread into the abdomen. This may lead to other serious medical problems such as sepsis (blood infection). Ask your child's caregiver if you are worried or have questions about your child's surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your child's surgery:

• Informed consent: You have the right to understand your child's health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your child's condition. Your child's caregiver should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives your child's caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to your child. Before giving your consent, make sure all your questions have been answered so that you understand what may happen to your child.
  
  
• Emotional support: You may stay with your child for comfort and support. Your child may need to stay in the hospital for more than a day. Ask caregivers if another family member can stay with your child when you cannot be there. Bring in something from home that your child likes. Your child may like to have his favorite blanket, toy, or clothing with him.
  
  
• Enema: Your child may need to have an enema before his surgery. This is liquid put into his rectum (rear end) to help empty his bowel.
  
  
• IV: An IV is a tiny tube placed in your child's vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Preoperative care: This is care given right before your child has a procedure or surgery. Your child may be given medicine to make him feel sleepy and more relaxed. Your child will be taken in a crib or wheelchair, or on a stretcher to the room where the procedure or surgery will be done. Your child may have special tubes put in him and equipment attached to him (such as IVs and monitors) during this time. Caregivers will stay with your child all the time to make sure he is warm, safe, and comfortable.
  
  
• General anesthesia: This medicine puts your child to sleep and makes him comfortable during surgery. It may be given in an IV or as a gas through a facemask. This medicine may also go through a tube placed in your child's mouth and throat. A mouth tube is called an endotracheal tube or "ET tube".
  
  
• Foley catheter: This is a tube that may be put into your child's bladder to drain his urine into a bag. The bladder is an organ where urine is kept. The foley catheter is usually taken out shortly after the surgery.
  
  
• Nasogastric or orogastric tube: A nasogastric (NG) or orogastric (OG) tube is inserted through your child's nose or mouth and down into his stomach. This tube keeps air and fluid out of the stomach during surgery.

During your child's surgery:

• Your child's abdomen and genital area will be cleaned with soap and water. Sheets will be put over him to keep the surgery area clean.
  
  
• During your child's surgery, a small incision is made in his belly button to insert the laparoscope through. Caregivers will insert other instruments by making 2 to 3 smaller incisions at different places on his abdomen. The abdomen is inflated with a gas (carbon dioxide) to lift the abdominal wall away from the internal organs. Clips, cautery, loops, or special staplers are used to separate the membrane of the appendix from the cecum. The appendix is then placed in a small bag and cut off using scissors. The end of the intestines (bowel) where your child's appendix was attached is stitched and closed. The incisions are closed by stitches or surgical tapes and covered with bandages.
  
  
• If the appendix has burst or has holes in it, the abdomen is thoroughly irrigated (washed out). This will be done after removing the appendix. Your child's caregiver leaves the skin open and allows it to heal on its own. He places a drain in the abdomen to allow pus and infected materials to leave your child's body.

After your child's surgery: Your child may be taken to a recovery room until he is fully awake. Caregivers will watch him closely for any problems. When caregivers see that your child is OK, he will be taken back to his hospital room. The bandages used to cover his stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your child's surgery to check his abdominal area. Ask your child's caregiver for more information about ways to prevent bleeding and take care of his incision.

• Activity: Your child's caregiver will tell you when it is OK for your child to get out of bed. Call his caregiver before letting him get out of bed for the first time. If he ever feels or looks weak, let him lie down right away. Then call your child's caregiver.
  
  
• Diet: Your child may be able to eat when bowel sounds (stomach growling) are heard. Your child's caregiver will listen to his abdomen for bowel sounds using a stethoscope. Small amounts of water are usually given first and then other liquids such as apple juice, breast milk, or formula that your child drank before surgery. If your child does not have problems after drinking liquids, caregivers may then let him eat soft foods. Some examples of soft foods are applesauce and mashed fruits or vegetables.
  
  
• Drains: These are thin rubber tubes which may be put into your child's skin that help drain fluid from around his incision. The drains are taken out when the incision stops draining.
  
  
• Medicines: Your child may need any of the following:
  
  
  • Antibiotics: Antibiotics may be given to help your child fight an infection caused by a germ called bacteria.
    
    
  • Anti-nausea medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Your child may have an upset stomach after surgery or taking pain medication.
    
    
  • Pain medicine: Caregivers may give medicine to decrease your child's pain. Tell a caregiver if your child's pain does not go away or comes back after taking this medicine. Pain medicine can have side effects. Tell a caregiver if your child has trouble breathing, is very sleepy, or has an upset stomach. Tell a caregiver if your child is allergic to any medicine.
  
  
• Monitoring: Caregivers may check for your child's pulses on his arms or wrists. This helps caregivers learn if he has problems with blood flow after his surgery. Your child may also have any of the following:
  
  
  • Vital signs: This includes taking your child's temperature, blood pressure, pulse (counting his heartbeat), and respirations (counting his breaths). To take your child's blood pressure, a cuff is put on his arm and tightened. The cuff is attached to a machine which gives your child's blood pressure reading. Caregivers may listen to your child's heart and lungs by using a stethoscope. Your child's vital signs are taken so caregivers can see how he is doing.
    
    
  • Intake and output (I&O):
    
    
    • Your child's caregiver may need to know how much liquid your child is getting and urinating. Caregivers may also want to know how much your child eats and if he had a bowel movement (BM).
      
      
    • Your child may need to urinate into a container in bed or in the toilet. A caregiver will then measure the amount of urine. If your child wears diapers, save them so a caregiver can weigh them. Do not throw away diapers or flush urine down the toilet before asking your child's caregiver.
  
  
• Oxygen: Your child may need oxygen to help him breathe easier. Your child may need a nasal cannula (small tubes placed in the nose) or mask. Many children do not like having these on their face, so caregivers may place the mask next to your child's face. Some children are placed in an oxygen tent or plastic hood. Do not take off your child's oxygen without asking your child's caregiver first.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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