Skin incision

The skin incision for appendicectomy should be ideally over the point of maximal tenderness. Often, this is McBurney's point and it necessitates McBurney's incision. A Lanz incision is an alternative but there is greater risk of nerve transection with subsequently increased risk of inguinal herniation.

An incision 4-6cm is usually adequate for most appendicectomies - it may be extended according to need.

In adverse circumstances, there are alternatives:

• presence of peritonitis: right paramedian incision provides better access for peritoneal toilet
• obese patients: extension of incision with division of rectus medially to gain adequate access
• incorrect diagnosis:
  • new incision e.g. paramedian
  • extension of incision e.g. to Pfannenstiel