Overview
Open Appendectomy is a surgical procedure used to remove the appendix through an open abdominal incision. It is an alternative to laparoscopic appendectomy and is used in certain situations.
Open appendectomy is crucial for treating acute appendicitis when laparoscopic approach is contraindicated or unavailable. It provides direct visualization and access to the appendix.
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Indications
Confirmed or suspected appendicitis
Inflammatory mass around appendix
Complicated appendicitis
When laparoscopy not possible
When laparoscopy unavailable
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, preoperative antibiotics, positioning, equipment setup, and team briefing. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Position patient, prep and drape, administer antibiotics.
⚠️ Common Mistakes to Avoid:
- Poor positioning
- Inadequate prep
- Missed antibiotics
💡 Pro Tip:
Position patient supine with arms abducted.
Step 2: Incision
Make McBurney incision (oblique RLQ incision).
⚠️ Common Mistakes to Avoid:
- Wrong incision
- Too small incision
💡 Pro Tip:
Use McBurney point for optimal access.
Step 3: Exploration
Explore abdomen, identify appendix.
⚠️ Common Mistakes to Avoid:
- Incomplete exploration
- Missed pathology
💡 Pro Tip:
Always explore for other pathology.
Step 4: Mobilization
Mobilize appendix, divide mesoappendix.
⚠️ Common Mistakes to Avoid:
- Inadequate mobilization
- Bleeding
💡 Pro Tip:
Carefully divide mesoappendix to avoid bleeding.
Step 5: Ligation
Ligate appendix base with suture.
⚠️ Common Mistakes to Avoid:
- Incomplete ligation
- Stump leak
💡 Pro Tip:
Place ligature at base of appendix.
Step 6: Division
Divide appendix above ligature.
⚠️ Common Mistakes to Avoid:
- Wrong division site
- Stump too long
💡 Pro Tip:
Leave 2-3mm stump.
Step 7: Closure
Close wound in layers, apply dressing.
⚠️ Common Mistakes to Avoid:
- Poor closure
- Wound infection
💡 Pro Tip:
Close fascia and skin properly.
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Post-procedure Care
Post-procedure care involves monitoring for complications, early ambulation, pain management, and discharge planning when criteria are met.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Bleeding | 1-3% | Hemodynamic instability, decreasing Hb | Exploration, hemostasis | Careful dissection, proper ligation |
| Infection | 5-10% | Fever, wound erythema | Antibiotics, drainage | Preoperative antibiotics, sterile technique |
| Stump leak | 1-2% | Peritonitis, abscess | Antibiotics, drainage | Proper ligation technique |
| Wound dehiscence | 2-5% | Wound separation, drainage | Wound care, reclosure | Proper closure technique |
Clinical Pearls
Use McBurney point for optimal access.
Always explore for other pathology.
Carefully divide mesoappendix to avoid bleeding.
Place ligature at base of appendix.
Leave 2-3mm stump to prevent leak.
Close fascia and skin properly.
Monitor for complications post-operatively.