APPENDICITIS AND APPENDECTOMY JOHN
WASHINGTON 2026 COMPREHENSIVE
SURGICAL CASE REVIEW QUESTIONS AND
SOLUTIONS VERIFIED
◉ What layers of bowel are transected at the appendiceal base?
Answer: Mucosa, submucosa, muscularis propria, and serosa.
◉ What distinguishes visceral from parietal pain? Answer: Visceral
is dull and poorly localized; parietal is sharp and well localized.
◉ Why divide the mesoappendix before addressing the base?
Answer: To control the appendiceal artery and mobilize the
appendix safely.
◉ Name three methods to control the appendiceal artery. Answer:
Energy device, clips, or vascular stapler.
◉ When is an endoloop preferred over a stapler? Answer: When the
base is small and not inflamed or friable.
, ◉ What must be confirmed before firing across the appendiceal
base? Answer: True base identified; no terminal ileum or cecum
trapped in the stapler.
◉ How do you avoid injuring the terminal ileum during division?
Answer: Maintain traction/countertraction and stay on the
mesoappendix.
◉ Why divide the stump flush with the cecum? Answer: To prevent
stump appendicitis.
◉ Typical insufflation pressure during laparoscopic appendectomy?
Answer: Usually 12-15 mmHg.
◉ When should a drain be considered? Answer: With gross
contamination, abscess cavity, or questionable source control.
◉ What intraoperative findings suggest perforation? Answer: Pus,
free fecalith, visible hole, abscess, gangrene.
◉ Typical port configuration for lap appendectomy? Answer:
Umbilical camera, suprapubic 5mm, LLQ or RLQ working port.
WASHINGTON 2026 COMPREHENSIVE
SURGICAL CASE REVIEW QUESTIONS AND
SOLUTIONS VERIFIED
◉ What layers of bowel are transected at the appendiceal base?
Answer: Mucosa, submucosa, muscularis propria, and serosa.
◉ What distinguishes visceral from parietal pain? Answer: Visceral
is dull and poorly localized; parietal is sharp and well localized.
◉ Why divide the mesoappendix before addressing the base?
Answer: To control the appendiceal artery and mobilize the
appendix safely.
◉ Name three methods to control the appendiceal artery. Answer:
Energy device, clips, or vascular stapler.
◉ When is an endoloop preferred over a stapler? Answer: When the
base is small and not inflamed or friable.
, ◉ What must be confirmed before firing across the appendiceal
base? Answer: True base identified; no terminal ileum or cecum
trapped in the stapler.
◉ How do you avoid injuring the terminal ileum during division?
Answer: Maintain traction/countertraction and stay on the
mesoappendix.
◉ Why divide the stump flush with the cecum? Answer: To prevent
stump appendicitis.
◉ Typical insufflation pressure during laparoscopic appendectomy?
Answer: Usually 12-15 mmHg.
◉ When should a drain be considered? Answer: With gross
contamination, abscess cavity, or questionable source control.
◉ What intraoperative findings suggest perforation? Answer: Pus,
free fecalith, visible hole, abscess, gangrene.
◉ Typical port configuration for lap appendectomy? Answer:
Umbilical camera, suprapubic 5mm, LLQ or RLQ working port.
