Post-Appendectomy Pain: Why Hemostatic Clips Remain - Surgery

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Appendicitis issues


On April 5th, I underwent laparoscopic surgery for acute appendicitis.
Since then, I still experience pain in the lower right abdomen.
However, a follow-up CT scan showed no abnormalities, and there is no sign of inflammation around the hemostatic clips.
Why were hemostatic clips placed inside the abdomen after the appendectomy?

Cai Chong, 20~29 year old female. Ask Date: 2018/06/25

Dr. Chen Jiaming reply Surgery


The appendix is a part of the gastrointestinal tract, and the normal intestine is supplied with blood vessels.
During laparoscopic appendectomy, it is necessary to first dissect and cut the blood vessels.
Vascular staplers are commonly used to manage the vascular dissection during laparoscopic procedures.
The stapler on the proximal side of the vessel remains in the body to maintain hemostasis.
Currently, the staplers used are made of titanium, which has good biocompatibility and does not require subsequent removal.
Most of the time, they do not cause any post-operative pain issues.

Reply Date: 2018/06/25

More Info


After an appendectomy, especially when performed laparoscopically, it is common for patients to experience some degree of pain in the right lower abdomen. This discomfort can persist for weeks or even months after the surgery. In your case, it has been some time since the procedure, and while imaging studies have shown no abnormalities, you are still experiencing pain.
The use of hemostatic clips during laparoscopic surgery is a standard practice. These clips are used to control bleeding by clamping blood vessels or tissues that may have been cut during the procedure. They are typically made of materials that are biocompatible, meaning they are designed to remain in the body without causing adverse reactions. The clips are left in place because they help ensure that any potential bleeding is effectively managed and that the surgical site heals properly.
It is important to understand that the presence of these clips does not usually cause pain. However, some patients may experience discomfort due to the healing process or from irritation of surrounding tissues. The pain you are experiencing could be attributed to several factors:
1. Healing Process: After surgery, the body goes through a healing phase where inflammation occurs. This can lead to pain as the tissues repair themselves. It is not uncommon for pain to linger even after the surgical site appears to have healed.

2. Nerve Sensitivity: Surgery can sometimes affect nearby nerves, leading to increased sensitivity or pain in the area. This phenomenon is known as neuropathic pain, and it can occur even if there are no visible signs of damage or inflammation.

3. Scar Tissue Formation: As the body heals, scar tissue can form. This tissue can sometimes adhere to surrounding structures, leading to discomfort or pain. In some cases, this can result in a condition known as adhesions, which may cause pain or complications in the future.

4. Muscle Strain: The abdominal muscles may also be strained during the surgery or during the recovery period, especially if you have been more active than usual. This can lead to localized pain in the area.

5. Psychological Factors: Sometimes, anxiety or stress related to the surgery and recovery can amplify the perception of pain.
If your pain persists or worsens, it is essential to follow up with your healthcare provider. They may consider additional evaluations, such as an ultrasound or MRI, to rule out any complications that may not have been evident on the CT scan.
In terms of management, here are some suggestions:
- Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help alleviate discomfort. Always consult your doctor before taking any medication.

- Physical Therapy: Engaging in gentle physical therapy or exercises can help strengthen the abdominal muscles and improve flexibility, potentially reducing pain.

- Heat Therapy: Applying a warm compress to the area may help relax the muscles and alleviate pain.

- Follow-Up Care: Regular follow-ups with your surgeon or primary care physician are crucial to monitor your recovery and address any concerns.

In summary, while the presence of hemostatic clips is a normal part of the surgical procedure and typically does not cause pain, the discomfort you are experiencing may be related to the healing process, nerve sensitivity, or other factors. It is essential to communicate your symptoms with your healthcare provider to ensure appropriate management and support during your recovery.

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