From the Research
The Kocher maneuver is the most commonly used technique to access and remove a retrocecal appendix, involving mobilization of the right colon by incising the lateral peritoneal attachments and reflecting the cecum and ascending colon medially. This technique is necessary because a retrocecal appendix is positioned behind the cecum, making it difficult to access through standard approaches. The Kocher maneuver allows the surgeon to identify the base of the appendix at the cecum, ligate the appendiceal artery, divide the mesoappendix, and remove the appendix.
Key Points
- The retrocecal position of the appendix occurs in approximately 65% of the population, making it the most common anatomical variation of the appendix 1.
- The Kocher maneuver is essential for accessing and removing a retrocecal appendix, as it allows for mobilization of the right colon and reflection of the cecum and ascending colon medially.
- In cases where laparoscopic approach is used, similar principles apply but with three ports for access.
- The suprapubic single-incision laparoscopic appendectomy is a nonvisible-scar surgical option that can be used for retrocecal appendicitis, providing better cosmetically appealing results than the standard umbilical access 2.
Considerations
- The retrocecal position of the appendix does not alter the presentation of appendicitis, and there is no statistical difference in duration of symptoms, presenting signs and symptoms, and initial white blood cell count between retrocecal and anterior appendicitis 3.
- The incidence of wound infections and other complications is increased in cases with perforation, but is not further increased by the retrocecal position 4.