Appendicitis Operation Site
Surgical Incision Location
For appendectomy, the surgical incision is typically placed in the right lower quadrant of the abdomen, though the exact location depends on whether an open or laparoscopic approach is used. 1
Open Appendectomy Incision
McBurney's point serves as the traditional landmark for open appendectomy, located at the junction of the lateral and middle thirds of a line drawn from the umbilicus to the right anterior superior iliac spine (ASIS). 2
However, this landmark has significant limitations in practice:
The actual appendix location varies considerably:
Laparoscopic Appendectomy Port Sites
Laparoscopic appendectomy is now the preferred surgical approach over open appendectomy, as it offers significant advantages including less pain, lower surgical site infection rates, shorter hospital stays, and better quality of life. 1
Conventional three-port laparoscopic appendectomy is recommended over single-incision techniques, as it results in shorter operative times, less postoperative pain, and lower wound infection rates. 1
Standard port placement for laparoscopic appendectomy typically includes:
- One umbilical port (camera port)
- Two additional working ports in the lower abdomen 1
Clinical Implications
The wide anatomic variation in appendix location (anterior intraperitoneal, retrocecal, pericolic gutter, retroileal, pelvic, or retroperitoneal) explains why less than half of patients with appendicitis have maximal tenderness at McBurney's point. 3
Both laparoscopic and open appendectomy are acceptable procedures, with the choice dictated by surgeon expertise, though laparoscopic is preferred where equipment and expertise are available. 1
Patients with hidden appendix locations are more likely to present with pain and tenderness outside the classic right lower quadrant, contributing to diagnostic delays and higher rates of complicated appendicitis. 4