1- Anesthesia:General or spinal.

2- Incision:
a) Mc Burney's incision: 5cm in length vertical on a line from umbilicus to A.S.I.S. at Mc Burney's point. done in uncomplicated cases.
b) Transverse or skin crease incision: 2 cm below umbilicus, centered on the midclavicular-midinguinal line
c) Rt. lower paramedian incision in peritonitis and unsure diagnosis.

3- Steps of Operation:

Mc Burney’s incision
- Cutting of the apponeurosis of the external oblique.
- Splitting of internal oblique muscle fibers
- Opening of peritoneum and delivery of the caecum.
- 3 taenia meet each other at the base of the appendix.

Ligation and division of mesoappendix
Crushing and ligation of the base of the appendix then appendix is removed
The appedicular stump is invaginated by burse string suture.
The wound is closed in layers.

m Complications of Appendectomy:
· Early: S.H.I.P +
- Bleeding per rectum due to slipped ligature at the base.
- Faecal fistula.
· Late:- Incisional hernia usually after wound infection.
- Direct inguinal hernia due to extended Mc Burney's incision ® injury of ilioinguinal nerve.

m Laparoscopic Appendecictomy:
Most valuable in management of suspected cases as a good diagnostic tool. It decreases the hospital stay time, but slightly longer operating time and higher costs limit its use.

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