DEVELOPMENT AND INNOVATIONS IN SCIENCE
International scientific-online conference
77
MODIFIED ACCESS IN ACUTE APPENDICITIS IN
PREGNANT WOMEN
Kasimova S.A.
Andijan State Medical Institute
https://doi.org/10.5281/zenodo.14202224
Relevance.
The most common chronic diseases in pregnant women are
diseases of the digestive system. During pregnancy, functional disorders of the
biliary system often occur, associated with a whole range of complex metabolic
and hormonal shifts. In the United States, according to experts, 40,000
appendectomies are performed each year on young healthy women in the
postpartum period. In healthy young women, pregnancy can be a risk factor for
the development of appendix pathology.
A method of appendectomy is known, which consists in the fact that access
is performed by a right oblique incision according to Volkovich-Dyakonov (see
Operative surgery and topographic anatomy. / Edited by V.V.Kovanov, Moscow:
Medicine, 1978). A 6-10 cm long incision is made parallel to the inguinal
ligament through the MacBurney point, located between the outer and middle
third of the line connecting the navel with the right anterior superior iliac spine.
One third of the incision is located above, two thirds below the specified line.
The length of the incision should be sufficient to ensure wide access. However,
this method is quite traumatic and is of little use in pregnant women.
Aim.
To improve the results of surgical treatment of acute appendicitis in
pregnant women.
Method.
The objective of the utility model is to create a method of surgical
access during appendectomy in pregnant women, providing the possibility of
surgical manipulations on the vermiform appendix in pregnant women,
including with a subhepatic or pelvic location, without a pronounced skin
cosmetic defect, reducing the trauma of the operation, the risk of developing
postoperative hernias and other postoperative complications.
The stated problem is solved by a method of surgical access during
appendectomy in pregnant women, including a skin incision in the right iliac
region from a point located between the outer and middle third of the line
connecting the navel with the right anterior superior iliac spine, downwards
perpendicular to the said line downwards with a length of 2 cm to 4 cm,
dissection of the aponeurosis of the external oblique abdominal muscle along
the course of the aponeurotic fibers, characterized in that in the upper corner of
the wound the incision of the aponeurosis of the external oblique abdominal
DEVELOPMENT AND INNOVATIONS IN SCIENCE
International scientific-online conference
78
muscle is extended upwards parallel to the edge of the rectus abdominis muscle
up to 2 cm in length, and in the lower corner of the wound the incision of the
aponeurosis of the external oblique abdominal muscle is extended downwards
parallel to the edge of the rectus abdominis muscle up to 2 cm in length.
The method is performed as follows.
The patient lies horizontally on her back. The surgeon is positioned on the right,
the assistant on the left of the patient. An incision is made in the skin and
subcutaneous tissue in the right iliac region, with the incision starting from the
MacBurney point located between the outer and middle third of the line
connecting the navel with the right anterior superior iliac spine. Then the
incision is made perpendicular to the said line downwards for a length of 2 to 4
cm. The aponeurosis of the external oblique abdominal muscle is dissected along
the course of the incision of the skin and aponeurotic fibers. In the upper corner
of the wound, the incision of the aponeurosis of the external oblique abdominal
muscle is extended upwards by 2 cm parallel to the edge of the rectus abdominis
muscle, and in the lower corner of the wound, the incision of the aponeurosis of
the external oblique abdominal muscle is extended downwards by 2 cm parallel
to the edge of the rectus abdominis muscle. The internal oblique abdominal
muscle and the transverse abdominal muscle are bluntly dissected along the
muscle fibers. The muscles are stretched with hooks along the length of the
wound, then the peritoneum is opened and an appendectomy is performed.
