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Appendectomy

The document outlines the anatomy, investigation methods, surgical approaches, and procedures for appendectomy, including potential complications and issues that may arise during surgery. It also discusses incidental appendectomy and its contraindications. Key surgical steps involve ligation of the appendicular artery and removal of the appendix while ensuring proper management of the surgical site to prevent complications.

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70 SASI KUMAR .R
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59 views17 pages

Appendectomy

The document outlines the anatomy, investigation methods, surgical approaches, and procedures for appendectomy, including potential complications and issues that may arise during surgery. It also discusses incidental appendectomy and its contraindications. Key surgical steps involve ligation of the appendicular artery and removal of the appendix while ensuring proper management of the surgical site to prevent complications.

Uploaded by

70 SASI KUMAR .R
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

APPENDICECTOMY

SASI KUMAR.R
FINAL YEAR STUDENT
❏ LOCATED at terminal end of caecum where 3
taeniae join,about 2 cm below the ileocecal
orifice.
❏ Appendicular artery, (branch of ileocolic artery).
❏ Accessory appendicular artery of Seshachalam
may be present.
Investigation
● Total leukocyte count increased

● C-reactive protein

● Ultrasound abdomen

● Contrast CT(Dirty fat thickened


mesoappendix, appendicular phlegmon, appendicular
faecolith and thickened caecum funneling contrast into
the orifice of the appendix as arrowhead sign)

● Plain x-ray(DU perforation,


intestinal obstruction, ureteric stone)
APPROACHES
● Gridiron incision : perpendicular to
right spinoumbilical line at
Mcburney’s point
● Rutherford Morison muscle cutting
incision
● Lanz crease incision : cosmetically
better
● Right lower paramedian
incision/lower midline incision
● Laparoscopic approach
● Fowler-Weir approach
Surgical
Procedure
● Under general anaesthesia, skin is incised.

● Two layers of superficial fascia are cut.

● External oblique apo neurosis 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 anti septics. Purse string suture is tightened


so as to bury the stump.
PROCEDURE
COMPLICATIONS
❏ Paralytic ileus
❏ Reactionary hemorrhage
❏ Residual abscess
❏ Pylephlebitis
❏ Adhesions,kinking and intestinal obstruction
❏ Right inguinal hernia
❏ Wound sepsis
❏ Faecal fistula
❏ Respiratory problems and DVT
PORTAL PYAEMIA

❏ Septic portal system thrombosis


❏ Immunosuppressed individuals
❏ Treatment : Antibiotics (cefoperazone,amikacin,
❏ Metronidazole, meropenem)
❏ fluid management ventilator support
TROUBLES DURING SURGERY
❏ The incision is small
❏ Appendicular tumor(large rt.hemicolectomy)
❏ Absence of appendix
❏ appendicular abscess
❏ Malignancy of caecum
❏ Gangrenous appendix involving base
INCIDENTAL APPENDICECTOMY
It means removal of normal appendix at laparotomy for another
condition
Examples:.
Ovarian cyst: Torsion (right) ovary is removed.

Contraindications for incidental appendicectomy


• Crohn's of caecum
• Radiation treatment of caecum
• Immunosuppression
• Vascular grafted patient (aortoiliac, etc.)
• Chances of infection are high in this group of patients. The
result will be faecal fistula-difficult to treat.
THANK YOU

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