From the Research
The recommended maneuver for tying the base of the appendix during a retrocecal appendectomy is to use a double ligation technique with absorbable sutures, as supported by the most recent and highest quality study 1. This technique involves mobilizing the appendix by dividing the mesoappendix and carefully dissecting the retrocecal appendix from its posterior attachments. Once the base is clearly identified, two separate absorbable sutures (typically 2-0 or 3-0 Vicryl or PDS) are placed around the base approximately 5mm apart, with the distal ligature placed first followed by the proximal one. Key points to consider when performing this technique include:
- Ensuring each ligature is securely tied to completely occlude the appendiceal lumen
- Transecting the appendix between the two ligatures using a scalpel or scissors, leaving a short appendiceal stump
- Using a specimen retrieval bag to reduce the risk of surgical site infection (SSI), as shown in the study 1 The double ligation technique is crucial for preventing contamination from appendiceal contents and reducing the risk of postoperative complications such as stump leakage or abscess formation. The absorbable suture material will gradually dissolve as the stump heals, eliminating the need for suture removal while maintaining adequate strength during the critical healing period. It is also important to note that the use of a specimen retrieval bag can reduce the risk of SSI, as demonstrated in the study 1, which found that no SSI was detected in the group that used the specimen retrieval bag. Overall, the double ligation technique with absorbable sutures is a safe and effective method for tying the base of the appendix during a retrocecal appendectomy, and its use in conjunction with a specimen retrieval bag can help minimize the risk of postoperative complications.