General Surgery

Appendicectomy (Open)

OPERATION: Appendicectomy (Open)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: Co-amoxiclav at induction
POSITION: Supine

INDICATION:
Acute appendicitis. [Clinical / CT / USS diagnosis].

PROCEDURE:
WHO Checklist performed. Skin prepared and draped.

Gridiron / Lanz incision in right iliac fossa. Layers opened in sequence. Peritoneum opened, pus evacuated and sent for MC+S if present.

Caecum delivered into wound by introducing a finger lateral to all bowel loops, into the right paracolic gutter, and the caecum hooked forward along a taenia coli to the appendix base. If appendix is retrocaecal, lateral caecal mobilisation performed and appendix dissected from its retroperitoneal position under direct vision.

Appendix identified. Mesoappendix divided between artery forceps in successive bites from tip to base, vessels ligated with absorbable suture. Appendicular vessels secured. Appendix base ligated with absorbable suture [purse-string suture to caecum used / not used]. Appendix divided and removed. Stump invaginated [if purse-string placed].

Peritoneum irrigated with warm saline. [Localised pus / free pus aspirated]. Drain placed to fossa [if appropriate].

Haemostasis confirmed. Instrument and textile count correct.

CLOSURE:
Peritoneum closed with absorbable suture. Muscle layers and external oblique closed in layers with absorbable suture. Skin closed with subcuticular absorbable suture / clips.

FINDINGS:
[Acutely inflamed / gangrenous / perforated] appendix. [Free pus / peritoneal contamination / none].

SPECIMEN: Appendix to histopathology. Pus swab if applicable.
EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Eat and drink as tolerated. Observations as per protocol. [Antibiotics if perforated].