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Short notes on an open appendicectomy:
Step 1 - Supine position.
Step 2 - Mc burney’s incision or bikini line incision.
Step 3 - Dissect through skin, sub cutaneous tissue with diathermy. Use self retaining retractor.
Step 4 - Divide ext oblique aponeurosis in the direction of fibers. Split internal oblique fibers in their direction.
Step 5 - Clips to peritoneum, lift it up and open with scissors. Make sure underlying structures not attached to peritoneum before opening.
Step 6 - Feel for appendix with index finger and deliver through the wound. Babcock to tip of appendix
Step 7 - Divide mesoappendix, ligate appendicular artery which runs along the border of mesoappendix.
Step 8 - Divide base of appendix between artery clips. Transfixation stictch (2-0 vicryl) and ligate the base
Step 9 - Bury with purse-string suture (3-0 prolene).
Step 10 - Wash out with water or saline and suction
Step 11 - Layer closure - close peritoneum with 2-0 or 3-0 vicryl
Step 12 - Layer closure - Interrupted stitches to internal oblique 2-0 vicryl
Step 13 - Layer closure - Close eternal oblique from lateral to medial with 2-0 vicryl
Step 14 - Layer closure - Close Scarpas with 2-0 vicryl
Step 15 - Layer closure - Close skin with 3-0 monocryl
Disclaimer: These notes are to act as an aide memoire. Different methods exist. Ensure you have the proper supervision before attempting an operation that you are not competent in.
Author:
Mr. Dev Mittapalli MBBS, MRCS (Eng)
| Speciality:
Surgical Procedures
| Date Added:
30/03/2013
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