If adequate access to the appendix cannot be obtained with the initial incision, extension can be undertaken. For example, a retrocaecal appendix may be difficult to retrieve with a standard Lanz incision. It may require a lateral extension of the deep incision into the abdominal wall muscles. Conversely, a medially sited or pelvic appendix may be more advantageously reached with division of the rectus sheath and medial retraction of rectus abdominis.
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