Open Appendicectomy operative surgery

OPEN APPENDICECTOMY- NEW SERIES OF OPERATIVE SURGERY VIDEOS


Dear viewers,
Greetings from “Surgical Educator”
Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries. However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery. Along with these videos, I recommend you to watch real operative surgery videos as well and I will give 2 links for each surgery which I think will be very useful. This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
Surgicaleducator.blogspot.com
Youtube.com/c/surgicaleducator
Links for real Open Appendicectomy:
https://www.youtube.com/watch?v=AGQ-PTm4-HA&oref=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DAGQ-PTm4-HA&has_verified=1
https://www.youtube.com/watch?v=4KHXgwFeG0E
Thank you for watching the videos.

1. OPEN APPNDICECTOMY DR.B.Selvaraj MS; Mch ; FICS; Professor of Surgery Melaka Manipal Medical College Melaka 75150 Malaysia OPERATIVE SURGERY

2. OPEN APPENDICECTOMY INDICATIONS: - Ac. Appendicitis - Subacute Appendicitis ANESTHESIA: - GA/ SA or Epidural POSITION: - Supine with slight left tilt Informed consent- risks of surgery: - Post-op adhesions < 4% - Intra abdominal abscess <5% - Fecal fistula < 2% - Wound infection high in perforation - Overall mortality from 0.2% for uncomplicated appendicitis to > 10% in perforated appendicitis

3. OPEN APPENDICECTOMY INCISION: ACCESS - McBurney’s - Lanz or modified McBurney’s - Rocky- Davis - Fowler- Weir medial extension - Rutherford Morrison lateral extension Division of External Oblique A poneurosis - Incise the aponeurosis of the external oblique along the line of its fibers

4. OPEN APPENDICECTOMY SPLITTING THE MUSCLES - Internal oblique & Transversus oblique muscles are bluntly spread apart with scissors - These muscles are held apart by 2 Richardson’s retractors INCISION OF PERITONEUM - Peritoneum is divided between 2 hemostats obliquely

5. OPEN APPENDICECTOMY Mobilisation of Cecal pole and delivering it into the wound - Identify Cecum by tenia coli and mobilise it with Babcock’s forceps and gauze piece - 3 tenia coli converge at base of appendix Anatomy of Appendix - Mesoappendix extends behind the ileum - Skeletonisation of mesoappendix should proceed to posterior surface of ileum

6. OPEN APPENDICECTOMY Skeletonisation of Mesoappendix - clamp and divide mesoappendix serially Crushing the base of Appendix - Crush the base of appendix with straight artery forceps for few minutes - Then remove and reapply few cms above

7. OPEN APPENDICECTOMY Ligation and removal - Appendix is ligated in the crush mark - Transact 0.5cm distally with knife Alternate method of removal - Mesoappendix and base of appendix both divided with a linear stapler

8. OPEN APPENDICECTOMY Appendiceal stump management - Appendix stump is inverted with purse string suture or Z stitch - I just cauterize the appendicular mucosa

9. OPEN APPENDICECTOMY Retrocecal appendix - Make a window in meso appendix near the base, crush the base and apply ligature - Divide the appendix at the base first Retro grade A ppendicectomy - Then serially clamp the mesoappendix and divide until you reach the tip of appendix

10. OPEN APPENDICECTOMY Closure of peritoneum - Wash with povidone iodine - Close peritoneum with vicryl Closure of muscles and skin - Close muscles also with interrupted vicryl - Close External oblique aponeurosis

11. THANK YOU R eal open appendicectomy links: 1.https :// www.youtube.com/watch?v=AGQ-PTm4-HA&oref=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DAGQ-PTm4-HA&has_verified=1 2. https://www.youtube.com/watch?v=4KHXgwFeG0E