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.

   Why: The point overlies the appendiceal base in most patients; a transverse incision follows Langer's lines and heals discreetly.

2. 02Muscle-splitting approach

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

   Why: Splitting rather than cutting means each layer's fibres close back over the others like a lattice, strength without a mesh.

3. 03Entering the peritoneum

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

   Why: In appendicitis, bowel can lie flush against the peritoneum; tenting creates the one centimetre of safety the blade needs.

4. 04Finding & delivering the appendix

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

   Why: The taeniae are the reliable landmark when inflammation distorts everything else, they always end at the appendiceal base.

5. 05Mesoappendix, base, removal

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

   Why: The appendiceal artery is an end artery, it does not stop bleeding by itself. The crushed, ligated base is what keeps cecal contents where they belong.

6. 06Closure

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

   Why: Each layer closed in its own plane restores the lattice the approach exploited; counts are confirmed before the fascia closes.

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.