Operation – after the patient is anaesthetised, the abdomen is again thoroughly palpated. This will give a clear idea regarding the size of the mass. Position of the caecum is ascertained to choose the right incision close to the appendix.
Incision – when the diagnosis is confirmed McBurney’s grid-iron incision is made. When diagnosis is in doubt right lower paramedian incision is preferred. Lanz’s transverse incision is very cosmetic and should be applied in cosmetically conscious patients. Rutherford’s Morison’s incision and Battle’s incision are hardly used and have fallen into oblivion.
McBurney’s grid-iron incision –
· This is an oblique incision through the McBurney’s point perpendicular to the spinoumbilical line at its junction between lateral 1/3rd and medial 2/3rd.
· Though this is the classical McBurney’s incision, yet the surgeon should try to feel the cecum and position the incision accordingly, as sometimes caecum may be abnormally placed(even sub-hepatic).
· The skin, Fascia of Camper and Fascia of Scarpa are divided along the line of incision.
· The fibres of the external oblique aponeurosis are split along the line of incision and retracted.
· The muscle fibres of internal oblique are now seen running perpendicular to the line of incision.
· These fibres and the fibres of the transversus abdominis are separated by inserting the tip of the artery forceps and opening it.
· The fingers are now introduced and these muscle fibres are retracted to expose the peritoneum.
· The peritoneum is picked up by two artery forceps and incised to enter the abdominal cavity.
Lanz’s Transverse incision-
· This incision is made at a level 2 to 3 cm below the umbilicus and is centred on the midclavicular-midinguinal line.
· The aponeurosis and the muscles of the abdominal wall are split or incised in the direction of the skin incision.
· This incision lies in the direction of skin wrinkle lines and is a better cosmetic incision than the McBurney incision.
· The only disadvantage of this incision is that the rectal sheath is opened at the medial end of the wound.
Paramedian incision-
· A vertical incision is made from 2.5 cm below the umbilicus 1.25 to 2.5cm to the right of the midline and ends just above the pubis.
· Skin, superficial fascia and fascia of Scarpa are incised along the line of incision.
· The anterior rectus sheath