The document outlines the procedure for open appendicectomy, including indications, anesthesia options, patient positioning, and informed consent details. It details surgical steps such as incision techniques, muscle handling, cecal pole mobilization, mesoappendix handling, and appendix removal methods. It concludes with guidelines for managing the appendiceal stump and closing surgical wounds.

1. OPEN
APPNDICECTOMY
DR.B.Selvaraj MS; Mch; FICS;
Professor of Surgery
Melaka Manipal Medical College
Melaka 75150 Malaysia
OPERATIVE SURGERY

2. OPEN APPENDICECTOMY
• INDICATIONS:
- Ac. Appendicitis
- Subacute Appendicitis
• ANESTHESIA:
- GA/ SA or Epidural
• POSITION:
- Supine with slight left tilt
• Informed consent- risks of surgery:
- Post-op adhesions < 4%
- Intra abdominal abscess <5%
- Fecal fistula < 2%
- Wound infection high in perforation
- Overall mortality from 0.2% for
uncomplicated appendicitis to > 10% in
perforated appendicitis

3. OPEN APPENDICECTOMY
• INCISION: ACCESS
- McBurney’s
- Lanz or modified McBurney’s
- Rocky- Davis
- Fowler- Weir medial
extension
- Rutherford Morrison lateral
extension
• Division of External Oblique
Aponeurosis
- Incise the aponeurosis of the
external oblique along the line
of its fibers

4. OPEN APPENDICECTOMY
• SPLITTING THE MUSCLES
- Internal oblique & Transversus
oblique muscles are bluntly
spread apart with scissors
- These muscles are held apart
by 2 Richardson’s retractors
• INCISION OF PERITONEUM
- Peritoneum is divided between 2
hemostats obliquely

5. OPEN APPENDICECTOMY
• Mobilisation of Cecal pole and
delivering it into the wound
- Identify Cecum by tenia coli and
mobilise it with Babcock’s forceps
and gauze piece
- 3 tenia coli converge at base of
appendix
• Anatomy of Appendix
- Mesoappendix extends behind the
ileum
- Skeletonisation of mesoappendix
should proceed to posterior surface
of ileum

6. OPEN APPENDICECTOMY
• Skeletonisation of Mesoappendix
- clamp and divide mesoappendix
serially
• Crushing the base of Appendix
- Crush the base of appendix with
straight artery forceps for few
minutes
- Then remove and reapply few cms
above

7. OPEN APPENDICECTOMY
• Ligation and removal
- Appendix is ligated in the crush
mark
- Transact 0.5cm distally with
knife
• Alternate method of removal
- Mesoappendix and base of
appendix both divided with a linear
stapler

8. OPEN APPENDICECTOMY
• Appendiceal stump management
- Appendix stump is inverted with
purse string suture or Z stitch
- I just cauterize the appendicular
mucosa

9. OPEN APPENDICECTOMY
• Retrocecal appendix
- Make a window in meso
appendix near the base, crush the
base and apply ligature
- Divide the appendix at the base
first
• Retrograde Appendicectomy
- Then serially clamp the
mesoappendix and divide until you
reach the tip of appendix

10. OPEN APPENDICECTOMY
• Closure of peritoneum
- Wash with povidone iodine
- Close peritoneum with vicryl
• Closure of muscles and skin
- Close muscles also with
interrupted vicryl
- Close External oblique
aponeurosis

11. THANK YOU
Real open appendicectomy links:
1.https://www.youtube.com/watch?v=AGQ-PTm4-
HA&oref=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv
%3DAGQ-PTm4-HA&has_verified=1
2. https://www.youtube.com/watch?v=4KHXgwFeG0E