September 27, 2010 · Leave a Comment
- The excision of the appendix usually performed to remove an acutely inflamed organ.
- Many surgeons perform an appendectomy as a prophylactic procedure when operating in the abdomen for other reasons. This procedure is then referred to as an incidental appendectomy.
- Supine, with arms extended on armboards
- McBurney (muscle splitting) incision.
- Laparotomy pack
- Four folded towels
- Major Lap tray or minor tray
- Internal stapling device
- Basin set
- Needle counter
- Penrose drain
- Culture tubes
- Internal stapling instruments
- An incision is made in the right lower abdomen, either transversely oblique (McBurney) or vertically (for a primary appendectomy).
- The surgeon’s assistant retracts the wound edges with a Richardson or similar retractor.
- The appendix is identifies and its vascular supply ligated.
- The surgeon grasps the appendix with a Babcock clamp, and delivers it into the wound site.
- The tip of the appendix may then be grasped with a Kelly clamp to hold it up, and a moist Lap sponge is placed around the base of the appendix (stump) to prevent contamination of bowel contents, in case any spill out occurs during the procedure.
- The surgeon isolates the appendix from its attachments to the bowel (mesoappendix) using a Metzenbaum scissors.
- Taking small bits of tissue along the appendix, the mesoappendix is double-clamped, and ligated with free ties.
- The base of the appendix is grasped with a straight Kelly clamp, and the appendix is removed.
- The stump may be inverted into the cecum, using a purse-string suture on a fine needle, cauterize with chemicals, or simply left alone after ligation.
- Another technique is to devascularize the appendix and invert the entire appendix into the cecum.
- The appendix, knife, needle holder, and any clamps or scissors that have come in contact with the appendix are delivered in a basin in the circulating nurse.
- The wound is irrigated with warm saline, and is closed in layers, except when an abscess has occurred, as with acute appendicitis.
- A drain may be placed into the abscess cavity, exiting through the incision or a stab wound.
- An alternative technique may be use the internal stapling device, by placing the stapling instrument around the tissue at the appendiocecum junction.
- By using the technique, the possibility of contamination from spillage is greatly reduced.
Perioperative Nursing Consideration
- Instruments used for amputation of the appendix are to be isolated in a basin.
- If ruptured, the case must be considered contaminated, and the surgeon may elect to use antibiotic irrigation prior to closure of the abdomen with an insertion of a drain.
- There may be no skin closure of the wound if the appendix has rupture.