Appendectomy Using the Linear Dissecting Stapler

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Appendectomy Using the
Linear Dissecting Stapler

Incidental appendectomy is frequently performed in association with other pelvic surgical procedures. It must be performed when there is clinical evidence of acute appendicitis.

The purpose of the operation is to remove the appendix prior to rupture in cases of acute appendicitis or where the appendix interferes with another operation, such as a right-colon continent urostomy.

Physiologic Changes. Although the appendix may be associated with the immune response, its exact function remains unclear. Generally, no obvious clinical physiologic change can be demonstrated after its removal.

Points of Caution. Hemostasis and aseptic removal of the appendix are keys to the success of this operation. Although the appendiceal stump has been inverted in some clinics, there are excellent studies showing no apparent sequelae from not inverting the stump.

Technique

A laparotomy is performed through a McBurney or a lower midline incision. If the diagnosis is uncertain and pelvic inflammatory disease is a possibility, the incision should be a lower midline rather than a McBurney incision.

Identification of the teniae coli on the cecum facilitates location of the appendix, which may be retrocecal. The appendix should be placed on traction. Adhesions in the area of the appendix are lysed with Metzenbaum scissors.

The mesoappendix is identified, and small hemostat clamps are used to open avascular sections in the mesoappendix between blood vessels. The LDS (linear dissecting) stapler (United States Surgical Corp.) is used to simultaneously staple and transect these blood vessels.

Figure 3 shows enlargement of the LDS placed on a blood vessel in the mesoappendix.

The appendix is transected with the LDS.

The completed operation shows the stapled appendiceal stump. Care should be taken to inspect the vascular staples on the mesoappendix blood vessels for bleeding.

The area should be irrigated with normal saline solution prior to closure of the abdominal wall. No drain is used.