APPENDECTOMY

(Acute Perforative Appendicitis with Generalized Peritonitis)

index

table of contents

my operations

How I did It?

Operative Technique:

Ø      Patient supine under SAB/CLEA/General Anesthesia

Ø      Asepsis and antisepsis technique

Ø      Sterile drapes placed

Ø      Incision made ( Rocky-Davis with Fowler-Weir/ Right Paramedian / Midline ),

      carried from skin through subcutaneous tissue

Ø      Fascia cut and opened, (Rocky-Davis, External oblique aponeurosis cut along its fibers; Right paramedian, Anterior Rectus Sheath cut and opened longitudinally; Midline, opened along linea alba)

Ø      Muscle splitting along muscle fibers done for Rocky-Davis and Right paramedian incisions

Ø      Peritoneum entered ( Rocky-Davis, peritoneum cut and opened transversely; Right paramedian, Posterior Rectus Sheath and peritoneum cut and opened longitudinally; Midline, peritoneum cut and opened longitudinally)

Ø      Intra-operative Findings noted

Ø      Intra-abdominal purulent discharge evacuated

Ø      Appendix identified

Ø      Mesoappendix serially clamped, divided and ligated

Ø      Base of appendix tied, milked, clamped and cut

Ø      Appendiceal stump painted with betadinized cotton

Ø      Copious peritoneal lavage

Ø      Hemostasis

Ø      Correct sponge/instrument count

Ø      Peritoneum closed continuously using vicryl 0 for Rocky-Davis; Peritoneum with posterior rectus sheath closed continuously for Right paramedian; Peritoneum and Fascia closed as single layer in midline incisions

Ø      NSS wash

Ø      External Oblique aponeurosis closed continuously in Rocky-Davis; Anterior Rectus sheath closed continuously in Right paramedian

Ø      NSS was

Ø      Skin left open

Ø      Wet to dry sterile dressing placed.