Friday, July 18, 2014

SURGICAL PROCEDURE 3 Pyloroplasty


3.  Pyloroplasty
Indications
•   In peptic ulcer to drain stomach after Truncal vagotomy.
•   In cancer esophagus after total esophagectomy.
Position
Supine.
Anesthesia
General.
Procedure
•   Locate pylorus.
•   Make a longitudinal incision, 3 to 5 cm on stomach side and 2.5 cm on duodenal side, cutting through the pylorus. Control all bleeding with ligatures.
•   Suture the longitudinal incision in a transverse direction using interrupted sutures.
Instruments
•   General set, 1
•   Gastrointestinal set, 1.

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Friday, July 11, 2014

SURGICAL PROCEDURE 2 Gastro-jejunostomy



2.  Gastrojejunostomy
Objective
In cases of obstruction of stomach outlet:
•   To establish alternative connection between stomach and small intestine.
•   To follow Vagotomy.
Position
Supine.
Anesthesia
General.
Procedure
•   Midline or Paramedian incision
•   Opening made in transverse mesocolon
•   Stomach antrum isolated tissue forceps at lesser and greater curvature
•   Jejunum also held in tissue forceps loop 10 to 20 cm form duodenojejunal junction
•   Non-crushing occlusion clamp applied
•   Two layers anastomosis 2/0 chromic
•   Outer continuous seromuscular
•   Inner continuous all layers
•   Anastomosis brought above the mesocolon tethered
•   Wound closed in layers.
Instruments
•   General set, 1
•           Gastrointestinal set, 1


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Friday, July 4, 2014

General Surgical Procedures 1 Truncal Vagotomy object position anaesthesia steps instruments




general surgical procedure
1.  Vagotomy
Objective
In case of peptic ulcer:
•   Division of Vagus Nerve below diaphragm
•   To reduce gastric acid secretion.
Position
Supine.
Anesthesia
General.
Procedure Steps
•   Incision Midline/Paramedian
•   Mobilize left lobe of liver
•   Liver colon and Small Intestines packed down and toward right
•   Mobilize lower esophagus
•   Sling round lower esophagus
•   Both nerves identified by palpation
•   Cut between ligatures
•   Specimen sent for histology for confirmation
•   Wound closed in layers.
Instruments
•   General set, 1
•   Gastrointestinal set, 1
•   Red rubber catheter (Sling).
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Friday, June 20, 2014

SURGICAL INSTRUMENTS More special nstruments








         The other special instruments in use are:
         •       Thompson lithotrite (Fig. 8.117)
         •       Turner Warwick calculus foreceps (Fig. 8.118)
         •       Rendal renal calculus forceps (Figs 8.119A to C)
         •       Millins boomrang needle (Fig. 8.120)
         •       Dupuytren’s aneurysm needle (Fig. 8.121)
         •       Joll aneurysm needle (Fig. 8.122)
         •       Syme aneurysm needle (Fig. 8.123)
         •       Satinsky clamp (Fig. 8.124)
         •       DeBakey aortic clamp (Fig. 8.125)
         •       Mini bulldog clamp (Fig. 8.126)
         •       Varicose stripper (Fig. 8.127)
         •       Dissectors (Mac Donald/Durham/Watson-Cheyne) (Fig. 8.128).
         Thompson lithotrie is used for crushing stones inside the urinary bladder the stone pieces are then sucked out under negative pressure this avoids opening the bladder.
         Turner-Warwick calculus forceps and Rendal renal calculus forceps are used to hold stones within the upper urinary tracts after exposing the kidney and ureter by surgery.
         Millins boombrang needle is an instrument used to stitch the capsule of the prostate after a retropubic prostectomy.
         Dupuytren’s aneurysm needle, Joll’s aneurysm needle, Syme’s aneurysm needle are blunt needles with handles for passing behind vascular pedicles after they have been cleanly dissected the eye with the thread helps to deliver it behind the pedicle which can thus be ligated
         Satinsky’s vena cava clamp is for holding the side of a vein opening it or repairing it.
         DeBakey’s aortic clamp is for holding the aorta or a part of it is closed during vascular operations.
         Mini bulldog clamp serves a similar purpose for smaller arteries.
         Varicose stripper used for stripping varicose veins. Dissectors are used to separate structures along tissue planes.
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