M.G. Kenjaev, MD, PhD, A.M. Kenjaev, Medical Center of the Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic (Director – T.T. Kasymbekov, MD) Abstract: A linear approach technique for appendectomy was developed and implemented in 26 patients, and indications for this technique were determined. The effectiveness of linear approach in appendectomy was demonstrated. The cosmetic significance of linear approach in appendectomy was determined. The correct choice of surgical approach largely determines the success of surgical intervention. Many surgical approaches have been proposed for performing appendectomy, including the oblique Riediger incision, the transverse Winkelmann and Sprengel approach, the longitudinal Schede incision, and others. The most widely used are the McBarney approach and its modification by N.V. Volkovich and L.I. Dyakonov, as well as the pararectal incision by Lenander. Each of these approaches has its own indications, advantages, and disadvantages. The main advantages of these incisions are their correspondence in most cases to the projection of the cecum, and the recommended incision length of at least 6 cm should provide, according to many surgeons [1, 2, 3, 4], sufficient visibility and room for maneuver. These arguments, of course, were justified by the corresponding course of time, when appendectomies were mainly performed under local anesthesia and surgeons could not accurately determine the location of the appendix before surgery. A significant drawback of existing incisions is that they run across the skin's lines of force, which in most cases results in coarse, deforming scars (hypertrophic, keloid), i.e., vascular and nerve fibers are severed. Furthermore, these approaches do not take into account the cosmetic results of the surgery. According to the combined data of many authors, in approximately one-third of cases, the appendix is ??located low and pelvic, yet surgeons continue to use the aforementioned approaches, which do not meet patients' aesthetic expectations. Modern imaging techniques (MT, MRI, ultrasound, laparoscopy) allow for precise determination of the appendix's location, and general anesthesia with good muscle relaxation creates optimal conditions for a smooth operation with a full exploration of the abdominal organs, even through minimal incisions. Therefore, the development of approaches for appendectomies depending on the location of the appendix, ensuring minimal trauma and good cosmetic results, is relevant. Purpose of the study. The aim of this study was to develop a linear approach and determine its indications for appendectomies. Materials and methods: The surgical department of the KSMA Medical Center has a 24-hour ultrasound service, allowing us to perform emergency abdominal ultrasound examinations on all patients admitted with suspected acute appendicitis. This allowed us to determine the precise location of the appendix and select the most optimal incisions, including the linear approach we developed. The typical Volkovich-McBarney approach involves an oblique incision parallel to the right inguinal ligament, above and below the line connecting the umbilicus and the anterior superior iliac spine, with one-third of the incision length above and two-thirds below this line. With the Lennander approach, an oblique longitudinal incision is made along the outer edge of the rectus abdominis muscle, with the line connecting the umbilicus and the anterior superior iliac spine projected along the midline of the incision. The Winkelmann-Sprengel transverse incision passes through the McBarney point, and the abdominal cavity is opened by transversely dissecting the anterior and posterior walls of the rectus sheath. In our modification, the incision begins below the line passing between the anterior superior iliac spines and is directed downward and medially along the lines of force of the skin corresponding to the underlying fibers of the external oblique muscle, extending up to 3-4 cm. After the skin incision, all remaining steps of the operation correspond to the classic appendectomy procedure. The advantage of this approach is that wound healing occurs without the formation of gross deformations with primary intention, since there is no transverse intersection of the lines of force along which the vascular and nerve fibers pass, as a result of which the innervation and trophism of the skin are not disrupted. In addition, this approach has an aesthetic aspect, since the resulting scar remains under the "bikini line", which is of important cosmetic importance. The indication for the use of this approach is the typical, medial and pelvic location of the vermiform appendix. We observed 26 patients with various forms of acute appendicitis in 2006, who underwent appendectomy using this approach. The age of the patients ranged from 6 to 55 years. Results and discussion: Of the 26 operated patients, 7 had catarrhal appendicitis, 18 phlegmonous appendicitis, and 1 gangrenous-perforative appendicitis, which was confirmed by histological examination of the removed appendices. Of all the patients, 15 had a typical appendix location, 9 had a pelvic location, and 2 had a medial location. A linear approach was used in 21 cases, with the Volkovich-McBarney approach used in 5. Given these appendix locations, bringing the dome of the cecum into the wound from the linear approach and performing an appendectomy presented no technical difficulties. Local serous peritonitis was confirmed intraoperatively in 14 patients, who received microirrigators in the abdominal cavity and removed them on the 2nd day. The average length of hospital stay was 3.9 days, and no postoperative wound complications were observed. Wound healing occurred by primary intention. Sutures were removed on the 5th-7th day. After analyzing the case histories of 26 patients and their treatment outcomes, we concluded that it is advisable to use a linear approach in appendectomies (taking into account the location of the appendix) because this approach reduces the risk of postoperative wound complications and improves the cosmetic outcome of the long-term results. Conclusions: 1. With a typical and pelvic location of the appendix, a linear incision can be used. 2. A linear approach that follows the lines of force of the skin reduces the risk of postoperative wound complications and promotes better healing. 3. The scar remaining on the skin after using a linear incision is projected below the bikini line, which is of great cosmetic importance for patients. References: 1. Kolesov V.I. Acute appendicitis. Leningrad, Medgiz, 1959, 289 p. 2. Matyashin I.M., Baltaitis Yu.V., Yaremchuk A.Ya. Complications of appendectomy. Kyiv "Health", 1974, 223 p. 3. Rusanov A.A. Appendicitis. M., "Medicine", 1979, 173 p. 4. Rotkov I.L. Diagnostic and tactical errors in acute appendicitis. M., "Medicine", 1980, 207 p.