Avoiding muscle cutting while extending McBurney's incision: a new surgical concept

Extending a McBurney's muscle-splitting incision, to achieve a better exposure when performing a difficult appendectomy, by muscle cutting may be associated with an increase in patient morbidity. In a retrospective study we Verified two actual indications that call for wound extension. The first is to correct a malpositioned first incision that does not match an existing anatomical variation in the region of the appendix. The second is to achieve a wide surgical space to deal with complicated cases. For each of these two indications, we thus introduced a new technique that fulfills the real requirement without muscle cutting. For the first indication we used a double muscle-splitting incision, while for the second indication we combined the original muscle-splitting incision with a vertical incision of the posterior lamina of the anterior rectus sheath. The two techniques are herein presented and the results of their application in 126 cases are discussed.