Appendectomy Development of the digestive system A

Appendectomy

Development of the digestive system A – 7 weeks (vitelline loop starts turning anticlockwise) B – 12 weeks C – 16 weeks D – 20 weeks

Large intestine

1 – superior mesenteric artery 2 – middle colic artery 3 – right colic artery 4 – ileocolic artery 5 – inferior mesenteric artery 6 – left colic artery 7 – sigmoideal arteries 8 – superior rectal artery 9 – middle rectal artery 10 – inferior rectal artery

Right sinus Left sinus

Position of the appendix in relation to the cecum. 1 – descending 2 – lateral 3 – medial 4 – retrocecal 5 – anterior (ventral) 1 2 4 3 5

Landmarks 1 – Mc. Burney's point 2 – Lanz point (lin. biiliaca) 1 2

Appendectomy

1 Dissection of the external oblique muscle aponeurosis

2 Splitting of the internal oblique end transversal muscles

3 Dissection of the parietal peritoneum between two pincers

4 Large dissection of the parietal peritoneum

5 Exteriorization of the cecum

6 Exteriorization of the cecum and extraction of the appendix

7 Applying a ligature on the mesentery

8 Dissection of the mesentery of appendix

9 Inserting pursestring suture

10 Applying a ligature on the base of appendix

11 Appendectomy!!!

12 Purse-string suture is being tightened while the appendiceal stump is dipped into the cecum

13 Inserting Z - suture

Retrograde appendectomy 1 Nipping of the base of appendix with forceps

2 Applying a ligature on the base of appendix

3 Dissection of the appendix

4 Inserting pursestring suture

5 Dissection of the mesentery using several forcepses and applying a ligatures on the mesentery stump

6

Retrocecal

Laparoscopic appendectomy