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.

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.