Open appendectomy

Why are we operating?

The classic muscle-splitting RLQ operation, and the traditional first case a student scrubs into.

Indication: Acute appendicitis, particularly where laparoscopy is unavailable or unsuitable.

The operation in 6 steps

1. 01Incision

   Transverse or oblique incision centred on McBurney's point.

2. 02Muscle-splitting approach

   Each abdominal wall layer is split along its own fibre direction: external oblique, then internal oblique and transversus.

3. 03Entering the peritoneum

   Peritoneum lifted between forceps, tented, and opened with the blade directed away from bowel.

4. 04Finding & delivering the appendix

   The cecum's taeniae are followed to their convergence; the appendix is delivered into the wound.

5. 05Mesoappendix, base, removal

   The appendiceal artery in the mesoappendix is clamped, divided, and ligated; the base is crushed, ligated, and the appendix amputated.

6. 06Closure

   Layers close in reverse: peritoneum, muscle layers approximated, external oblique, Scarpa's, skin.

Danger zones

• Iliohypogastric nerve

  Runs between the oblique layers; injury causes groin numbness and weakens the inguinal canal mechanism.

• Cecum

  Immediately deep to the peritoneum; the reason the peritoneum is tented before opening.

• Appendiceal artery

  An end artery in the mesoappendix, secure ligation is the operation's key vascular step.

Anatomy you need

Follow the taeniae coli down the cecum; they converge on the appendiceal base wherever the tip is hiding.

What can go wrong

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.

• Intra-abdominal abscess

  Swinging fevers, malaise, and localized pain from day 5 onward, classically after perforated appendicitis.

• Postoperative ileus

  Distension, absent flatus, intolerance of diet, and quiet bowel sounds in the days after abdominal surgery.