If open appendectomy is chosen for treat appendicitis, the surgeon must then decide on the location and type of incision. Prior to incision, a single dose of antibiotics should be administered, typically a second-generation cephalosporin.The appendicitis patient should be re-examined after the induction of general anesthesia, which enables deep palpation of the abdomen. If a mass representing the inflamed appendix can be palpated, the incision can be centered at that location. If no appendiceal mass is detected, the incision should be centered over McBurney’s point, one-third of the distance from the anterior superior iliac spine to the umbilicus. A curvilinear incision, now known as a McBurney’s incision, is made in a natural skin fold. It is important not to make the incision too medial or too lateral. An incision placed too medial opens onto the anterior rectus sheath, rather than the desired oblique muscles, while an incision placed too lateral may be lateral to the abdominal cavity.
Once the diagnosis of appendicitis is made, the surgeon must decide whether to perform an open (OA) or laparoscopic (LA) appendectomy. Numerous randomized controlled trials have compared these two methods for treat appendicitis, sometimes with conflicting results. Meta-analyses and systematic reviews have combined these studies to address the controversy (See table below). These meta-analyses have similar findings, which can be summarized in appendicitis surgery as follows:
(1) OA can be performed more quickly;
(2) LA patients have less postoperative pain and reduced narcotic requirements;
(3) there is a trend toward reduced length of stay with LA;
(4) LA patients have fewer wound infections;
(5) OA patients develop fewer intra-abdominal abscesses;
(6) LA patients return to work more quickly;