Appendectomy - Dr. Tamer Ashraf

This video shows an open appendectomy through a Lanz incision in a 9 year old boy The incision is placed centered over the MacBurnie’s point which is the surface marking of the base of appendix). It is two-thirds down a line joining the umbilicus to the anterior superior iliac spine • the incision is transverse or slightly oblique allowing extension medially and laterally if needed. • The subcutaneous tissues and scarp’s fascia are divided with diathermy clearly exposing the external oblique aponeurosis. this facilitates it’s subsequent closure. • The external oblique Aponeurosis is incised and then split along the line of its Fibers running downwards and medially. • The internal oblique muscle fibers are now in view. They are split at a right angle to the direction of the Fibers and two Langenbeck retractors are used to extend the splitting including the underlying transversus abdominis muscle fibers. • The peritoneum is now grasped with two forceps, taking care to avoid grasping the underlying bowel. the forceps are raised and the peritoneum is incised; the opening is enlarged using scissors. • the cecum is delivered into the wound. the anterior teniae coli is followed and pulled leading to the base of the appendix . If the cecum cannot be delivered easily, lateral peritoneal attachments may require dissection first. • the appendix is controlled by traction using two Babcock forceps The appendicular artery runs in the free border of the mesoappendix. A mosquito forceps is passed at the base of the mesoappendix to pass a suture. The artery is carefully ligated in continuity The mesoappendix is then divided by cautery. The mesenteric division should continue to the base of the appendix . Any residual small vessels may be controlled by cautery. • The base of the appendix is gently crushed just above its origin and the clamp is placed distally a few more millimetres. The appendix is tied at the crushed area and removed by sharp division just proximal to the clamp. The mucosa of the remaining stump may be cauterized. • the distended cecum may prove difficult to return to the abdomen. Gentle emptying allows gradual safe repositioning back into the abdomen • The edges of the peritoneum are grasped and closed with a continuous absorbable suture. • The Fibers of the transversus and internal oblique muscles are approximated using two or three interrupted sutures, which are tied loosely to avoid muscle ischemia. • The external oblique muscle is closed with a continuous absorbable suture. • Scarpa’s fascia closed with an absorbable suture. followed by the skin can then be closed by sub cuticular sutures Don’t forget to like and subscribe to see more entertaining medical educational videos! See more lectures, articles, and more on the Stay Current app: