Variables in right iliac fossa anatomy and their relevance to appendicectomy: improving knowledge and practices

The anatomy of the right iliac fossa was reappraised with the intention of improving, open appendicectomy. The surface anatomy was studied on volunteers and the internal topography was examined during the operation of appendicectomy. Our findings vary slightly from prevailing knowledge which is mostly based on cadaver anatomy. Our findings suggest that McBurney's point is very close to the rectus sheath in some individuals and in most subjects it does not overly base of appendix. Surgical teaching through most of the 20th century stressed safety and recommended large incisions with generous exposure, allowing surgeons to operate yet not appreciate these variables. An attempt is made to provide a precise account of the variables in right iliac fossa anatomy to help surgeons operate using smaller, minimally invasive incisions with the inevitable reduced exposure of local anatomy. The proximity of the base of the appendix to the ileocaecal junction raises concern that burial of the appendicular stump might distort local anatomy.