PYLOROPLASTY PROCEDURE 3

PYLOROPLASTY

What are the indications of pyloroplasty?

·        In cases to avoid holding up to stomach contents.

·        In patients of peptic ulcer after truncal vagotomy.

·        In patients having cancer of oesophagus after total oesophagectomy to enlarge the passage of the pylorus.

Position of the patient

Suspine.

Anaesthesia given

General.

Surgical steps

·        First the pylorus is located and a longitudinal incision, 3 – 5 cm on stomach side and 2.5cm on duodenal side is given cutting through the pylorus. All bleeding is controlled with ligatures.

·        The longitudinal incision is sutured in a transverse direction using interrupted sutures.

Instruments used

General set, 1

Laparotomy set, 1

Fine artery forceps, 4

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.surgseminar.blogspot.com

www.drmmkapur.blogspot.com .

GASTRO JEJUNOSTOMY PROCEDURE 2

When is gastrojejunostomy carried out?

· Gastrojejunostomy is carried out in cases of obstruction of stomach outlet.

· This can result because of cancer or an ulcer of the stomach.

· To establish alternative connection between stomach and small intestine.

· To follow vagotomy.

Position of the patient

Supine.

Anaesthesia given during this procedure

General.

Procedure

· A midline or paramedian incision is made, next an opening is made in transverse mesocolon.

· Stomach antrum is isolated and tissue forceps is applied at lesser and greater curvature of the stomach.

· The jejunum is also held by tissue forceps loop 10 – 20 cm from duodenojejunal junction.

· Next non-crushing occlusion clamp is applied.

- Two-layer anastomosis with 2/0 chromic is now carried out. The outer is continuous (in the seromuscular layer) and the inner continuous to all layers.

- Also anastomosis is brought above the mesocolon tethered.

- Wound is closed in layers.

Instruments

General set, 1

Laparotomy set, 1

Fine artery forceps, 5

Visit www.drmmkapur.blogspot.com

www.surgseminar.blogspot.com

VAGOTOMY PROCEDURES 1

VAGOTOMY

When is vagotomy done?

In cases of peptic ulcer:

· Divison of vagus nerve below diaphragm

· To reduce gastric acid secretion.

Position of the patient

Supine.

Anaesthesia

General.

Steps of surgical procedure

· The incision is given in midline/paramedian.

· Next mobilized left lobe of liver.

· Liver, colon and small intestine packed down and towards right.

· Mobilise lower oesophagus.

· Both nerves identified by palpation.

· Cut between ligatures.

· Specimen sent to histology for confirmation.

Instruments

General set, 1

Laparotomy set, 1

Any questions be sent to drmmkapur@gmail.com
All older posts are stored in archives for access and review
Visitors that follow may post contributions.
To create consumer/provider engagement visit www.surgseminar.blogspot.com
www.drmmkapur.blogspot.com 

VASCULAR INSTRUMENTS

VASCULAR INSTRUMENTS

Varicose stripper

Varicose stripper is used for stripping varicose veins in the long or short saphenous system.

Aneurysm needles

Aneurysm needles are of great value during surgical procedure.

They are blunt needles with handles for passing behind deep vascular pedicles after they have been clearly dissected;

the eye with the thread helps to deliver it behind the pedicle which can thus be ligated.

They were designed to ligate feeding vessels of aneurysm.

The curvature at the end is to suit the direction of the feeding vessel to be ligated.

The next three instruments are required when there is accidental injury to a vein or an artery.

De Bakey aortic is used for holding and closing the aorta or a part of it during vascular operations or injury to a last vessel.

Mini bulldog clamp serves a similar purpose for smaller arteries to hold and repair.

Satinski clamp is used for holding the slide of a vein for opening it or repairing a tear in it

Any questions be sent to drmmkapur@gmail.com
All older posts are stored in archives for access and review.
Visitors that follow may post contributions to the site.
To create consumer/provider engagement visit www.surgseminar.blogspot.com
www.drmmkapur.blogspot.com