The level of approach for appendectomy.

Save you! This is a traditional McBride incision appendectomy.

Take MacKay incision (take one-third of the connecting line between navel and right anterior superior iliac spine as a vertical line, which is MacKay incision, with a general length of about 5cm). The skin, subcutaneous tissue and aponeurosis of the external abdominal oblique muscle were cut in turn, and then the muscles of each layer were blunted and separated. When you see the fat in front of the peritoneum, you almost reach the peritoneum. Then lift the peritoneum, cut it open, and it will enter the abdominal cavity. Look for the appendix along the colon band. After finding the appendix, generally speaking, anterograde resection is done, that is, resection is started from the end. First, clamp the mesoappendix in an avascular mesoappendix, cut it off and ligate it (note that the ligation is tight, and bleeding of appendix artery can lead to death). Then clamp the appendix about 0.5cm away from it, and cut it off after double-layer silk thread ligation. Conventional "Sanxiang" treatment of appendix stump (Sanxiang used to be carbolic acid, alcohol and normal saline, but now it is simplified to iodophor for three times), and then purse-string suture of appendix stump (it can also be figure-eight suture, and some books even say that appendix stump can be fixed on the omentum as long as it is embedded). Rinse the surgical field with normal saline. After no obvious bleeding, check the gauze and instruments and close the abdomen layer by layer.

Retrograde appendectomy is a step to reverse antegrade appendectomy. It is often used when the terminal adhesion is serious and the appendix cannot be completely detached.