SURGICAL PROCEDURE
Pre-operative Preparation for Surgery
Before moving the patient in the operating room, she was asked to sign a consent form that gives permission to
do the procedure.
Preparation of Surgical Instruments
Check the equipment and ensure that the theater has been cleaned before the trolley is set, then, they prepare the
instruments and equipment needed in the operation. Uses sterile technique for scrubbing, gowning and gloving.
The utilized instrument were:
Anesthesia
Prior to the surgery, the patient instructed to position into the left lateral decubitus for administration of
Regional anesthesia to numb the lower extremities. Regional anesthesia is a type of pain management for
surgery that numbs a large part of the body, such as from the waist down. The medication is delivered through
an injection or small tube called a catheter and is used when a simple injection of local anesthetic is not enough,
and when it’s better for the patient to be awake
Positioning of the Patient
Afterwards, the patient instructed to position into supine.
Antiseptic Cleaning & Draping
The surgeon applied 7.5% povidone -iodine on the abdomen of the patient then she wiped with wet gauze then
applied 4.5% povidone -iodine and wiped with wet and dry gauze on the incision site . Then they place sterile
drapes to prevent contamination of suture material and to maintain a sterile field at the surgical site.
Incision
After the skin preparation, the surgeon began the incision through vertical midline incision . Incision will begin
using blade no.21 and cautery pen to prevent excess bleeding. Then the surgeon started to incise the
subcutaneous layer ,and cauterized. Cautery can maintain hemostasis if blood vessels are transected. Then the
surgeon used 3 Allis forceps to hold the subcutaneous tissue and place a baby Richardson to retract the
subcutaneous layer. . Expose the external aponeurosis in a superolateral to inferomedial fashion along its fibers
to expose the underlying internal oblique muscle. Use blunt dissection to divide the internal oblique
perpendicular to the direction of the fibers to expose the transverse abdominal muscle, which is divided in a
similar fashion to expose the peritoneum. Grasp the peritoneum with Kelly forceps, and if there is no adhesion,
then incise it with a scalpel.
Locating the Appendix
Surgeon start to locate the appendix by locating the cecum, it can be mobilized and used to identify the
appendix. Alternatively, the cecum can be used as a guide to locate the appendix.
Removing the Appendix
Once the appendix is identified, dissect the mesoappendix, divide the appendiceal vessels between clamps, and
ligate them with silk sutures. Crush the tissue at the appendiceal base with a right-angle clamp. Move the clamp
distally and ligate the appendiceal base distal to the clamp with an absorbable suture. Excise the appendix
proximal to the right-angle clamp with a blade. The appendiceal stump mucosa can be obliterated using
electrocautery. Place a silk purse-string suture around the appendiceal base and invert the stump.
Closing of the Peritoneum and Fascia
Closing of the peritoneum Using 4 Kelly to clamp then close using Chromic 2/0 continuous stitching. Before
the surgeon closes off the fascia, the oblique muscles and the subfascial tissues are inspected to ensure
hemostasis.
Closing of the Abdomen
The surgeon then closed fascia using an absorbable suture in a running non locking fashion. The subcutaneous
tissues are then irrigated, and hemostasis is assured. The last is to close the incision. Abdomen is then closed .
Even in class III (contaminated) wounds due to perforated or gangrenous appendicitis, primary skin closure, and
broad-spectrum antibiotic coverage are recommended.
