This document summarizes the surgical procedure of appendicectomy. It describes 5 common incision approaches for the surgery, including the gridiron incision at McBurney's point. It outlines the steps of the procedure, which involves identifying the appendix, ligating its base with sutures, and removing the appendix. Potential complications are also noted, such as finding a normal appendix, appendicular tumors, abscesses, or identifying other conditions like Crohn's disease during surgery.

1. Appendix
SRB
Treatment
Surgery-Appendicectomy:
Approaches
1. Gridiron incision:
- incision is placed perpendicular to the right
spinoumbilical line at the McBurney's point
(i.e. at the junction of lateral one-third and
medial two-third of spinoumbilical line)
- Gridiron is a frame of cross beams to support
a ship during repairs.
- This incision was first described by McArthur
2. Rutherford Morison's muscle cutting incision
- Muscles are cut upwards and laterally
3. Lanz crease incision
- centering at McBurney's point
- cosmetically better.
4. Right lower paramedian incision/lower midline
incision
- when in doubt or when there is diffuse
peritonitis.
5. Laparoscopic approach: Becoming popular
6. Fowler-Weir approach
- by cutting muscle medially over the rectus
Procedure
- Under general anaesthesia, skin is incised. Two layers of
superficial fascia are cut. External oblique aponeurosis is
opened in the line of incision. Internal oblique and
transverse muscles are split in the line of fibres.
Peritoneum is opened in the line of incision. Caecum is
identified by taeniae, and ileocaecal junction. Omentum
when adherent is separated. Appendix is held with
Babcock's forceps. Mesoappendix with appendicular
artery is ligated. Using thread or silk, a purse--string
suture is placed around the base of the appendix. Base
of the appendix is crushed with artery forceps and
transfixed using vicryl (absorbable). Appendix is cut
distal to the suture ligature and removed. Stump is
cleaned with antiseptics. Purse string suture is tightened
so as to bury the stump
- In difficult cases-Retrograde appendicectomycan be
done. In presence of pus or burst appendix, the
peritoneal cavity is drained
- Postoperatively, IV fluids, antibiotics are given. Once
bowel sounds are heard, oral diet is started

2. Troubles in Appendicectomy
- During surgery if appendix is found normal, other cause
for symptoms should always be looked for like Meckel's
diverticulum, Crohn's disease, ovarian/pelvic causes in
females, malignancy, etc.
- Appendicular tumour may be fou nd. If it is in the tip,
appendicectomy is sufficient. It could be carcinoid
tumour. If it is in the base right hemicolectomy is done.
- Absence of appendix-a rare occasion can occur.
Caecum and taeniae should be traced properly before
finalising it.
- Appendicular abscess/pelvic abscess formation.
- Malignancy in the caecum is identified on table-right
hemicolectomy should be done.
- If Crohn's disease is identified during surgery,
appendicectomy can be done with care, if base of the
appendix is normal. But in rare occasion where appendix
is involved by Crohn's disease, appendicectomy should
not be done but treated only with antibiotics and steroids,
otherwise fistula can develop.