Appendicectomy steps of operation

33 surgery recentadvance

Preparation:

  • Prophylactic antibiotics
  • Bladder should be empty
  • General Anaesthesia
  • WHO time out
  • Position Supine – may need head down
  • Antiseptic dressing and draping

Ports:           

  • 10mm Umbilical port open technique – insert camera in – will be working port later
  • 5mm suprapubic
  • 5mm Left iliac fossa

Steps:

  • 5 mm Camera in LIF port after insertion of all ports
  • Working ports suprapubic and umbilical
  • Perform diagnostic laparoscopy look for other causes e.g. pelvic organs, Meckels diverticulum
  • Aspirate fluid pus if present and sent for C/S
  • Expose appendix – may need head down, right side up
  • This is difficult in the video presented

 

  • Free appendix from tip to the base . Held appendix and divide mesoappendix close to appendix wall using diathermy. The division of mesoappendix may need clip or suture in the mesoappendix depending upon inflammation and anatomy – In this video there is application of haemolock. In easy appendices this is easily done by diathermising the mesoappendix close to appendix wall.
  • If there is any faecolith spillage as in this video make sure this is collected in Birt bag to prevent loosing this in the peritoneal cavity.

 

  • Apply endoloop to appendix base
  • Divide appendix and collect in Birt bag
  • Remove appendix and Birt bag via umbilical port
  • Wash out using generous amount of normal saline as in this case particularly if the appendix is inflamed like this
  • Drain has been placed here due to presence of pus and bad inflammation but this is not necessary in most instances
  • Close umbilical fascia using 1/0 vicryl or 1/0 PDS
  • Inject 20 ml marcaine 0.5%
  • Close skin
  • Antibiotics may be indicated further if pus present as in this case

 

 

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