With the appendicular blood supply ligated, prepation is made for removing the appendix. First, a purse-string suture is applied a short distance distal to the base of the appendix. Vicryl or chromic catgut are suitable sutures. The stitch is applied in the seromuscular layer circumferentially taking bites of the taenia coli.
Then, two artery forceps are placed transversely across the base of the appendix just distal to the purse-string suture. The more proximal forceps are used to crush the appendix and then are removed and reapplied beyond the distal forceps. A ligature is applied around the crushed area and secured; chromic catgut or vicryl is suitable.
An incision is made between the two forceps to free the appendix. The specimen is sent for histology. The forceps are freed from the remaining stump of the appendix and the latter is invaginated into the caecum through the centre of the purse-string. The purse-string suture is pulled together and tied. Consequently, the stump comes to lie internal to the caecum. Although widely practiced, there is no good evidence that inversion of the stump produces superior healing.
Last reviewed 01/2018