What is the average recovery time?
If it’s appendicitis on an otherwise healthy 24-year-old, we might watch
them for eight hours post-op and send them home the same day. If the
appendix is starting to fall apart and there’s a lot of inflammation, I
might give them an extra dose of antibiotics and keep them over night
before sending them home the next day. If the appendix is ruptured
and the area needs to be cleaned out, sometimes we’ll keep them a
few days on antibiotics.
What else have I not asked about appendicitis that the average person should know?
Operation wise, appendix removal is straightforward. I make three little
incisions and use a dissecting trocar so you don’t have to cut through the
abdominal wall. It kind of splits the tissue and you’re in the belly without
having to make an incision. Then when you pull it out, everything closes
back up and you don’t even have to put in abdominal wall stitches.
However, sometimes what looks like appendicitis in a woman might be
a ruptured ovarian cyst or inflamed ovaries. I tell all patients ahead of
time: sometimes we may find something different.
You said appendectomies are typically laparoscopic, is gall bladder surgery the
same process?
Typically, if you’re having symptomatic gall bladder disease, we rec-
ommend taking it out if you’re otherwise healthy. But, if a patient is
really sick, we can drain the gall bladder and then take it out once we
get their other issues under control.
I’m seeing a woman today; she’s going to get a percutaneous (through
the skin) drain. They’ll put her in the CAT scan. The radiologist will guide
a needle into it, put a little wire in there and over the wire, we will drain
the gall bladder. That’s under sedation and local anesthesia.
The woman I’m seeing today is really sick. She has a bad heart and bad
lungs, so I don’t want to put her to sleep with a breathing tube and all
that stuff. The gall bladder is acutely inflamed, but draining will take
care of the immediate problem. Then we’ll try to take care of some of
the other issues before going back and taking care of the gall bladder
at some point. Drainage is just a temporizing thing when you want to
avoid a surgery that’s a big stress on the body.
4
What appears to be appendicitis can be a few other afflictions. Is a suspected gall
bladder inflammation typically just that?
Most of the gall bladders I remove, the patients are having symptomatic
gall bladder disease. It’s usually from gall stones, although an inflamed
gall bladder can happen without gall stones. Most of the ones I take out,
I’ll see electively in the office. Most have had an ultrasound or another
test that indicates gall bladder disease. Some of the symptoms are
fist-like pressure, sometimes sharp pain in the back, and nausea. Once
you’re having symptoms, your risk of having a more acute attack goes up.
My understanding is that appendicitis can become severe quickly. Is the same true
of gall bladder infections?
The gall bladder can become obstructed and gangrenous. You can start
having pain and then 24 hours later it may be severe. It can be blocked,
fall apart and start leaking bile, then you get sicker and sicker. Other
times, you can have blockage for months with intermittent discomfort.
It’s variable. Sometimes the gall bladder needs to come out because
liver function is abnormal, and they’ve passed stones into the bile duct.
That’s a whole other ball of wax. But sometimes we’ll take it out for that
reason too. Occasionally I’ll get a call from the ER saying they have
a hot gall bladder, exquisite tenderness when they try to take a deep
breath. I’ll admit them, put them on antibiotics and we’ll take it out.
Is recovery for gall bladder surgery easy?
Once the gall bladder is removed, most patients can go home an hour
and a half later. They can ingest liquids that day, regular food the next
day. I usually tell people to take a couple weeks but some go back to
work in a week.
What else should a layperson know?
Having gall stones doesn’t mean you must have your gall bladder re-
moved, just when its symptomatic or there are some other issues like
liver function abnormalities. The gall bladder used to be taken out even
if it was asymptomatic but good literature says you don’t have to do
that anymore. Typically, if they have one attack or episode, it’ll recur
and become more frequent over time.
VITAL SIGNS Volume 12 • Issue 2