APPENDECTOMY

(Acute Perforative Appendicitis with Generalized Peritonitis)

Operative Technique:

Patient supine under SAB/CLEA/General Anesthesia

Asepsis and antisepsis technique

Sterile drapes placed

Incision made ( Rocky-Davis with Fowler-Weir/ Right Paramedian / Midline ),

carried from skin through subcutaneous tissue

Fascia cut and opened, (Rocky-Davis, External oblique aponeurosis cut along its fibers; Right paramedian, Anterior Rectus Sheath cut and opened longitudinally; Midline, opened along linea alba)

Muscle splitting along muscle fibers done for Rocky-Davis and Right paramedian incisions

Peritoneum entered ( Rocky-Davis, peritoneum cut and opened transversely; Right paramedian, Posterior Rectus Sheath and peritoneum cut and opened longitudinally; Midline, peritoneum cut and opened longitudinally)

Intra-operative Findings noted

Intra-abdominal purulent discharge evacuated

Appendix identified

Mesoappendix serially clamped, divided and ligated

Base of appendix tied, milked, clamped and cut

Appendiceal stump painted with betadinized cotton

Copious peritoneal lavage

Hemostasis

Correct sponge/instrument count

Peritoneum closed continuously using vicryl 0 for Rocky-Davis; Peritoneum with posterior rectus sheath closed continuously for Right paramedian; Peritoneum and Fascia closed as single layer in midline incisions

NSS wash

External Oblique aponeurosis closed continuously in Rocky-Davis; Anterior Rectus sheath closed continuously in Right paramedian

NSS was

Skin left open

Wet to dry sterile dressing placed.