the Linear Dissecting
Sigmoid Colostomy With Hartmann's Pouch
of a Loop
of the Colon With Low
the Gambee Suture
of Colon to Rectum
Using the End-to-End
of the Colon With
Low Anastomosis via
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.
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
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
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.