Appendicectomy: My Experience

What is an Appendicectomy?

The appendix is a small pouch attached to the large intestine. If it gets infected through a condition called appendicitis, the common emergency surgery to help the patient is an Appendicectomy or the removal of the Appendix.

The Procedure

At the operating table, I spoke to the gastrointestinal surgeon who explained some of the basic processes as he was performing them.

The removal of the Appendix from the patient requires regional anesthesia from the top down. (I will be postings specifically about anesthesia in the coming weeks) The abdomen can be divided into 9 sections [123, 456, 789] where the right side from a patient perspective (1,4,7) has the appendix and liver, and the left side (3,6) has the spleen.

The patient is awake and conscious during the entire procedure. The regional anesthetic was given in the spinal column below the lumbar section. The patient is asked about various pain and location starting at the foot and going up to above the lower abdomen stomach region. By asking about the pain, the surgeon can recognize when to start the procedure.

No intubation is required because of regional anesthetics. First local anesthesia is applied to the location then the spinal needle or (epidural needle) is used to give anesthetic to spinal cerebral fluid for regional anesthetic function. An appendicectomy can be performed as an open surgery where the lower abdomen is physically opened, or laparoscopically, where three tubes are inserted and a camera is used to guide instruments leading to the removal. This surgery was an open appendicectomy.

When the surgeon started to perform the initial incision, the operating theatre power went out. The lights shining on the lower abdomen were turned off which left the surgeons unable to continue with the procedure. Keep in mind, this type of occurrence usually will unlikely happen in a more urban hospital. The hospital I was shadowing was a rural hospital in India.

Later during the procedure, after the abdomen was opened and the appendix was visible, the power cut out again. This was more dangerous as the body was exposed and there was limited time based on blood loss, etc. The surgeon chose to wait it out for a few minutes, and luckily the power recovered to finish the appendix removal.

After the surgery, it was deemed a success and the patient was sutured closed. The consciousness of the patient was tested by curling of hands and tongue and asking for names throughout the experience and particularly at the end.

My Thoughts

This was the first surgery I physically shadowed. After shadowing in the United States, I guess I had certain expectations about the surgical environment from TV shows and such. As I stepped into the operating room, many nurses and surgeons were hustling around, with medical equipment all over, and tight quarters in general.

I probably wouldn't recommend such an invasive open surgery as your first shadowing experience just because it was quite overwhelming because there as so many unknowns. For example, I was amazed by the comfort of the surgeon as they placed their hands into incisions pulling back skin and fat and clamping it down. The smell of skin and flesh is also quite distinct but over time with various other surgical shadowings, I got quite accustomed.

Specifically, I got to see the appendix after its removal. The surgeon said they would send it to the lab to get it tested afterward in case of cancer or another disease to inform the patients. The surgeon explained that this was quite a routine procedure and that this particular appendix looks healthier than others he had seen. He also suggested watching a laparoscopic surgery which I ended up watching later that week.

Overall, the appendicectomy gave me a great overview of gastrointestinal surgery and a glimpse into the surgical environment. I did end up watching more gastrointestinal surgeries which will be covered in other posts shortly.

Below shows the infected appendix after it was removed. Click past the disclaimer to see.