My greatest wish is to help growing general surgeons, so that they can grow up quickly and healthily, with fewer detours and fewer falls. Here are some of my surgical tips that I have accumulated over the years, and I would like to share them with you! I hope that growing general surgeons can get effective advice from them! I hope that high level general surgeons can give their advice! I hope high level general surgeons can give their advice and suggest more reasonable methods. 1, appendectomy a (1) even if the diagnosis is clear before surgery, after successful anesthesia still again abdominal examination, more than half of the cases can be palpated abnormalities, that can further confirm the diagnosis, but also can indicate the location of the appendix. (2) If a mass is palpated, centered on the McKenicke’s point, the mass located outside and below is mostly an abscess formed by the appendix and the peritoneum of the iliac fossa, about 5*7 in size, which should be protected by opening the abdomen. Directly above and below the inner part are mostly large omental wraps, about 3*6 in size, and attention is paid to the treatment of the large omental remnant cavity after removal of the appendix. The outer upper part is mostly retroperitoneal or posterior appendix. In addition to the appropriate upward movement of the incision, intraoperative attention should be paid to turn the appendix inward (not upward) to facilitate the treatment. The medial upper part is mostly an appendiceal abscess located under the end ileal mesentery, and the mass is often huge. The medial direction is mostly for appendiceal adhesions with the retroperitoneum, which are easily combined with pelvic abscesses. (3) Incision selection, rather up than down, but it should be noted that more than 2 cm above the McKay’s point, the external oblique abdominal muscle is no longer a layer of tendon membrane, but two membranes sandwiching a meat. The McDonald’s point is determined: there is an error in visual inspection, the ruler is called a joke, and it is not standard to rely entirely on the pressure pain site incision, a simple method is to place the left thumb on the anterior superior iliac spine, the index finger is located in the middle and inner third of the line between the umbilicus and the anterior superior iliac spine, and the skin forceps are placed in the middle and outer third, which is clear at a glance and has minimal error. 2, appendectomy II (1) The size of the incision, depending on the person, remember to give yourself leeway, it is not honorable to extend the incision intraoperatively. The length of the incision should not be arbitrary, should be planned in advance for the suture, for example, 3 cm incision sewing two stitches exactly, if 2.5 cm also need two stitches, for nothing to increase the difficulty of the operation. 3.5 cm two stitches will not be sewn, three stitches and redundant. (2) open abdomen: follow the principle of minimally invasive, the incision should not only be small, the damage to the layers of the incision should also be small, small outside and large inside is superficial, is a false minimally invasive. After cutting the skin, the vascular clamp props up the center of the incision, downward electric knife cut straight to the extra-abdominal oblique tendon membrane, cut to lift the extra-abdominal oblique tendon membrane, and then cut the subcutaneous tissue to both sides, the length of the cut corresponds to the incision. This minimizes the subcutaneous gap and maintains the original appearance of the tissue. Even in particularly obese patients, it is easy to open the abdomen with one and a half people (three hands) (note: to maximize resources, individual cases will indicate how many hands are actually needed, and only those that play a complete role in the operation will be counted as one hand). The gap between the peritoneum and the abdominal wall muscles should be properly separated before incision of the peritoneum, and the opening can be tension-free suspension of the peritoneum to protect the incision. In patients with possible sepsis, the gauze angle should be placed outside the peritoneum to remove overflowing pus, and immediately after incision, the gauze should be filled into the incision and the remaining peritoneum incised outside the gauze. Do not contaminate the incision in order to collect pus. (3) Exploration: If pus is seen in the abdominal cavity, it should be cleared first, following the standard for clearing the abdominal cavity before completion of surgery. Otherwise, you will see constant spillage of pus affecting the view, contaminating the incision, or a pus-soaked finger or appendix entering or leaving the incision. (4) Finding the appendix: The easiest way to find the appendix is to reach into a finger within 5 seconds, but requires extensive experience. The more common method is to look along the colonic band, which is very familiar to everyone and not much to say. Let’s talk about how to find the cecum. Many young people find that after opening the abdomen, there is no room to find the cecum as there is small intestine everywhere. Introduce two methods: First, the inner line: raise a section of small intestine under the incision, fingers follow its ligament after straight to the root of the near ligament, and then turn right, if not blocked by the appendix, more can be raised back to the blind. Second, external line: lift the lateral peritoneum and lift it inward along the lateral peritoneum, straight to the cecum. Similar to lifting the bottom of the hernia sac. 3. Appendectomy III (1) Stump treatment: First, stump encapsulation is not mandatory, and for a congested and edematous thickened appendix, it is best to choose not to encapsulate. If there is a strong demand for embedding, the pulpy muscle layer can be cut on both sides of the appendiceal root, and the stump can be easily pressed under the pulpy muscle layer, and the pulpy muscle layer can be intermittently sutured. The suture sequence is best to start with the first counterclockwise stitch in the lower right corner, followed by the upper right, upper left, and lower left, so that all stitches are in prograde without reverse suturing, which is useful for young surgeons. Before tying the knot, the left hand lifts the purse string, which is easy to reveal and makes the purse string slightly tighter, and the right hand clamps the stump into the purse (the first half is recommended to be done by the main surgeon), and hands it to the assistant to press and tighten the purse. For those who have a soft appendix but still cannot be buried, attention should be paid to whether the appendectomy is incomplete, as if no one can bury the stump on the appendix. (2) Pelvic pus removal: Suction and irrigation can remove some of the accumulated pus, but pus moss cannot be removed and gauze is still needed to clean it up. How to deliver the gauze to the pelvic cavity without hurting the intestinal canal, it is best to use the rolling entry method. First, one corner of gauze is sent into the iliac fossa, then the middle of gauze is sent to the outside of the original gauze corner by pressing it against the pelvic wall. At this time, attention should be paid to push the gauze as a whole gently inward to push out the space, then the gauze can continue to advance, and finally, the back gauze corner is rolled into the pelvic floor by pressing it against the gauze entered first. (3) Bleeding treatment: common bleeding sites a. Abdominal wall muscles. When separating the muscle more than 3 cm, it will damage the upstream blood vessels in the muscle, at this time, as long as the pull hook is not loose, the clamp electrocoagulation can be; b. Tear of the mesentery. Tighten the ligament after suturing, do not try other methods; c, residual cavity bleeding, mostly large omental bleeding, can be raised to remove. If it is peritoneal bleeding, drainage can be placed after compression. (4) Appendectomy IV (1) Appendiceal abscess For safety reasons, appendiceal abscess is best treated conservatively. If surgery is necessary, please note that only those with gangrene or perforation in the mid-to-last segment will form an abscess, at which time the appendiceal root is usually intact because the appendiceal cavity has been decompressed, and can be started from the appendiceal root. (2) Colon tumor if intraoperatively found to be cecum tumor, it is best to perform another incision for radical surgery, I have performed many cases of right hemicolectomy via McKinsey’s incision, only one experience ——- pain. There are other surgeries to be continued ~~~~~