Always give prophylactic antibiotics, at least to cover anaerobes.
Oblique in the right iliac fossa through McBurney's point. This allows access to the base of the appendix irrespective of where the tip is located. An alternative is the Lantz incision. Further details are available in Surgical Technique & Technology - Surgical Technique.
- The external oblique is opened in the line of the incision & the muscle layers split to expose the peritoneum. the peritoneum is opened.
- If pus is evident a culture swab is taken for microbiological assessment.
- The appendix is located digitally & delivered into the operative field. If this is not possible then retrograde appendicectomy is performed.
- The mesoappendix is divided & ligated.
- The base of the appendix is ligated with an absorbable ligature. The appendix is clamped distal to this & excised.
- A purse-string seromuscular absorbable suture may be placed 1-2 cm from the appendix base. the stump is then buried & the suture tied.
- It is not necessary to bury the appendix stump especially if the caecum is inflamed.
- Saline irrigation may be used.
Closure and Drainage
In layers wiht absorbable sutures - the skin, in uncomplicated cases, may be closed with a subvuticular suture. If pus is encountered, the skin may be left open or loosely approximated. Drains may be used when an abscess is encountered.