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Appendectomy Images

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Appendix location beneath skin.
VID 115, frame 2

appG4034

 

McBurney incision line.
VID 115, frame 2

appG4037

 

Incision line relative to rectus abdominis.
VID 115, frame 3

appG4039

 

Rocky-Davis transverse incision line.
VID 115, frame 4

appG4040

 

Cecum and appendix relative to iliac fossa.
VID 115, frame 5

appG4042

 

Direction of deepening the incision should be 45 degrees from vertical.
VID 115, frame 6

appG4044

 

Vertical incision may end up outside the peritoneal reflection.
VID 115, frame 7

appG4045

 

Skin incision.
VID 115, frame 8

appP4046

 

Incision deepened to external oblique aponeurosis using electrocautery.
VID 115, frame 9

appP4048

 

Nick is made in external oblique with knife.
VID 115, frame 10

appP4049

 

External oblique opened using Mezzenbaum scissors.
VID 115, frame 11

appP4050

 

External oblique edges retracted with McBurney or Roux retractors (not shown).
VID 115, frame 12

appP4051

 

Fascia on surface of internal oblique is incised sharply in the line of the muscle fibers.
VID 115, frame 12

appP4052

 

Two large blunt clamps (Pean) inserted perpendicular to each other.
VID 115, frame 13

appP4054

 

Muscle fibers are spread down to the level of the transversus.
VID 115, frame 13

appP4055

 

Two fingers used to gently spread internal oblique fibers.
VID 115, frame 14

appP4056

 

Iliohypogastric nerve.
VID 115, frame 15

appL4057

 

Transversus muscle split to expose preperitoneal fat and underlying peritoneum.
VID 115, frame 16

appP4058

 

The peritoneum may show signs of inflammation.
VID 115, frame 17

appP4060

 

Peritoneum is picked up and the resulting fold is pinched between two fingers.
VID 115, frame 18

appP4061

 

Nick is made in peritoneal fold, and cultures taken of any fluid present.
VID 115, frame 19

appP4062

 

Peritoneum opened a short distance in the line of incision.
VID 115, frame 20

appP4063

 

Appendiceal artery.
VID 115, frame 21

appG4065

 

Normal appendix.
VID 115, frame 22

appG4066

 

Early appendicitis.
VID 115, frame 22

appG4067

 

Suppurative appendicitis..
VID 115, frame 23

appG4068

 

Gangrenous appendicitis.
VID 115, frame 23

appG4069

 

Perforated appendix.
VID 115, frame 24

appG4070

 

Exploratory finger sweep from lateral parietal peritoneum under appendix toward medial side.
VID 115, frame 25

appG4073

 

Mobilization of appendix by finger dissection.
VID 115, frame 26

appP4074

 

Appendix bluntly separated from an adherent blanket of omentum.
VID 115, frame 27

appP4075

 

Cecum gently lifted into wound by hooking a finger under a taenea.
VID 115, frame 28

appG4077

 

Cecum broadly grasped with a moist sponge and gently rocked back and forth to deliver it and the attached appendix.
VID 115, frame 29

appG4078

 

Mid portion of appendix sometimes tethered down by a band which must be cut to mobilize the appendix.
VID 115, frame 30

appG4080

 

Retrocecal appendix.
VID 115, frame 31

appG4082

 

If appendix is retrocecal and retroperitoneal, it is necessary to mobilize the cecum from the lateral peritoneal reflection.
VID 115, frame 32

appG4084

 

Appendix mobilized into the wound and the base is visualized at its junction with the cecum.
VID 115, frame 33

appP4085

 

Appendiceal mesentery is clamped.
VID 115, frame 34

appG4086

 

Clamped appendiceal mesentery is ligated and divided from distal to proximal.
VID 115, frame 34

appG4089

 

Appendix base milked distally and doubly ligated.
VID 115, frame 35

appG4092

 

Appendix cut off flush with bottom of straight clamp using a knife blade.
VID 115, frame 36

appP4093

 

If base is friable or gangrenous, it can be left openů
VID 115, frame 37

appG4094

 

...and secured by inversion...
VID 115, frame 37

appG4096

 

...and cecal purse string suture.
VID 115, frame 37

appG4097

 

Appendix specimen.
VID 115, frame 38

appP4098

 

Peritoneum closed with continuous absorbable 4-0 suture material.
VID 115, frame 39

appP4099

 

Internal oblique closed by suturing fascia on its outer surface.
VID 115, frame 40

appP4100

 

External oblique aponeurosis closed with continuous 4-0 absorbable suture.
VID 115, frame 41

appP4101

 

Scarpa's fascia tacked together with three interrupted sutures.
VID 115, frame 42

appP4102

 

Skin closed with staples if contamination has not been excessive.
VID 115, frame 43

appP4103

 

This page was last modified on 1/29/2000.
 

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