Procedures
Laparoscopic appendectomy
One-Minute Overview
Indications
Acute appendicitis (uncomplicated and complicated), perforated appendicitis with peritonitis, and selected interval appendectomy after non-operative management. Selection depends on the clinical course, age, and concern for neoplasm.
Positioning
Supine. Trendelenburg with left lateral tilt to displace bowel away from the RLQ and improve visualization of the cecum and appendix.
Key Anatomy to Know Cold
Cecum, taenia coli (converge at appendiceal base), mesoappendix, appendiceal artery, terminal ileum, ileocecal junction. A retrocecal appendix lies behind the cecum; reported frequency varies by population and study.
Critical Concept -- Identifying the Appendix
Follow the taenia coli to their convergence at the base of the cecum -- this leads reliably to the appendiceal base. In retrocecal cases, the cecum may need to be mobilized medially.
Major Complications
Surgical site infection, intra-abdominal abscess, stump leak, injury to right ureter or iliac vessels, ileus.