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Operative Note:Appendisectomy

Name of procedure
LAPAROSCOPY AND OPEN APPENDISECTOMY, T5 emergency procdure, General anaesthetic

Indication
Symptoms and signs of peritonitis maximal in the right iliac fossa.

Preparation
Incision
12 mm Blunt port inserted subumbilically using open `Hassan' technique, 5 mm port inserted suprapubically under direct vision.
Findings
Acute retrocaecal gangrenous appendicitis, pus in pelvis and along right paracolic gutter. Normal uterus, tubes and ovaries, laparoscopy otherwise unremarkable; proceed to open appendisectomy
Procedure
Open appendisectomy;
Incision
Lanz incision including lateral part of rectus sheath
Findings
Pus ++ in peritoneal cavity swab sent for C/S. Acute retrocaecal gangrenous appendicitis with imminent perforation at site of faecolith
Procedure
Appendisectomy (stump not buried) specimen sent in formalin for histology, haemostasis, local peritonal wash out appendix bed and pelvis with warm saline
Closure
Layers 2/0 Vicryl, 2 x 3/0 nylon verticle mattress to skin, Betadine wick to skin wound. Wound pad. Fascia at umbilical incision closed with 0 Maxon, skin with 4/0 nylon. Steristips to suprapubic skin incision
Post operative instructions


next up previous contents
Next: Flow charts (Available on Up: Operative Notes Previous: Operative Note:Varicose Veins   Contents
Adrian P. Ireland