[Trans-sheath laparotomy of the rectus muscle in appendectomy]

Reference to personal experience covering 2035 appendicectomies is referred to in an account of the technique of transvaginal laparotomy of the rectus muscle. Here the sheath of the rectus and the peritoneum are incised at different levels and in different directions. The outside border of the sheath is not touched and the muscle is displaced medially, without section or displacement of the muscle fibres. If required, the operation can be extended upwards or downwards into a pararectal incision without departing from the context of the sheath. The technique is easy and gives ample vision. Closure is simple, rapid and cosmetically satisfying. The resulting solidity of the wall means that laparocele does not occur.