IrishMedicalNews

Modified Lanz incision can simplify difficult appendicectomies

Written by Lloyd Mudiwa Monday, 30 November 2009 15:25

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Three surgical trainees at Antrim Area Hospital, Northern Ireland, have developed the first practical response to improved anatomical knowledge of the position of the appendix. They hope the new technique will assist fellow trainees to perform, more easily, appendicectomies which could become more difficult with increasing obesity.

“We conclude that the junior surgical trainee should place their incision for an appendicectomy via a modified Lanz incision. It has served us well and we wish to share this experience with our fellow junior colleagues,” they wrote.

Although most appendicectomies, the most frequently performed surgical procedure, are clearly routine and suitable for junior staff to perform under supervision, as many as 20 per cent are, for a variety of reasons, considered difficult, they added.

Commenting on the modification in the International Journal of Surgery, the trainees wrote: “Still a cosmetically pleasing incision formed in a skin crease, it is placed one centimetre higher. We have found and evidence points to the fact that the base of the appendix commonly lies higher than McBurney’s point and better access can be achieved to a high-lying appendix through this opening. Increasingly in western society we are encountered with obese patients in whom the position of the umbilicus can descend significantly. Therefore, choosing a modified Lanz incision in these circumstances is particularly important.”

In 87 appendicectomies performed via the modified approach, the trainees reported that their incision was not only over the base of the appendix in a greater majority of cases, but also gave an improved access.

This, they said, would be sufficient to deal with rarities such as the subhepatic appendix.

They added: “One problem with our approach, however, is the lack of access to the female pelvis for inspecting the tubo-ovarian pathology, but given that laparoscopic appendicectomy is increasingly being considered to be the gold standard for females with a possible appendicitis the relevance of this fact is diminished.”