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
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