Editing Appendicectomy

== Pre-op ==

* Ensure the bladder is empty

== Laparoscopic appendicectomy ==

* Technique
** Infra-umbilical Hasson
** Decide on next two ports      (usually supra-pubic and LIF)
** Use a universal and a bowel      grasper to identify appendix, find the TI, orient it
** Decide how to take it out -      antegrade vs retrograde
* Difficulty
** Extra port
** Mobilise caecum inferior to      superior (watch out for ureter, stay in correct plane, anterior to      Gerota's)
** Retrograde appendicectomy
*** Divide appendix at base
*** Endoloops x2 to base
*** Dissect along appendix       until you reach the tip and remove
** Convert to open

== Open appendicectomy ==

* Mark a line between ASIS and     umbilicus, and mark Mcburney's point 1/3 of the way to umbilicus
* Make 5cm incision at     McBurney's point along Langer's lines
** Can also do Rockey-Davis      (transverse) incision
* Carry incision down to     aponeurosis of external oblique, and divide in direction of fibres to     expose internal oblique
* Divide IO and expose     transversus abdominis, which is split to expose peritoneum
* Elevate peritoneum and divide     with Metz scissors
* Identify caecum and appendix
* Divide mesoappendix between     two Kelly clamps and tie off
* Ligate appendix and divide
* No need to invert the stump
* Close in layers: first     peritoneum and transversalis, then IO, then EO, then skin



Drains only necessary for abscess cavities

== Complications: ==

* Wound infection 3-10%, mostly     with perforated
* Abscess - 1%
** If <4cm, can be safely      managed non-op
** Percutaneous drainage is the      other option

[[Category:Colorectal]]
[[Category:Intern education]]