Appendectomy (Open, Laparoscopic)

Procedure Snapshot

• Indication: Acute appendicitis.
• Expected duration: ___
• Special instruments: Ports, stapler, endoloops.

Step Workflow

1. Supine; establish pneumoperitoneum.
2. Identify appendix via teniae coli.
3. Divide mesoappendix with energy device/stapler.
4. Secure base with loops ×2 or stapler.
5. Transect appendix; bag retrieval.
6. Irrigate if perforated; close fascia ≥10 mm ports.

Key Pimp Questions

• Q: Lap vs open outcomes?
  A: Lap = ↓ wound infection, ↑ abscess (PMID 21263308).
• Q: When ileocecectomy?
  A: Necrotic cecal base.
• Q: Antibiotic duration if perf?
  A: 3–5 days (PMID 25992746).

Critical Anatomy

• Landmarks: Teniae coli convergence, cecal base.
• Danger zones: Retrocecal ureter.

Informed Consent Highlights

• Risks:
  • Bleeding ___
  • Abscess ___ (PMID 26154746)
  • Wound infection ___ (PMID 21263308)
  • Ileocecectomy ___

Post-op Considerations

• ERAS; early diet, ambulation.
• Discharge when afebrile.

References

• Chassin’s, Appendix chapter.
• Clinical Scenarios, Appendix chapter.
• Mentula 2015 (PMID 26154746).