APPENDICECTOMY PROCEDURE

APPENDICECTOMY

What are the indications of appendicectomy?

· In cases of acute or recurrent acute infection (acute or recurrent acute appendicitis) of the appendix or tumors of the appendix (carcinoid)

· Access to the organs in the right iliac fossa.

· To excise the diseased appendix.

Positions of the patient

Supine.

Anaestheia given

General, epidural or spinal.

· A right gridiron incision is given.

· Caecum is identified and a Taenia coli to the base of the appendix is traced.

· Next the appendix is mobilised to its base by dividing mesoappendix between ligratures.

· The base of appendix is crushed with haemostat and the crushed area is tied with 2/0 silk ligrature.

· A cut is given above tie and appendix is removed and sent for histopathology analysis.

· The appendicular stump is inverted with a purse-string on the caecum.

Instruments used

Appendicectomy set

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Bowel Anastomosis

When is an intestinal resection indicated?

The operation may be required in the following cases:

· In cases of strangulation and gangrene of bowel

· Volvulus

· Intussusception (irreducible)

· Tuberculosis of intestine with stricture

· Intestinal fistula

· Regional enteritis

· Ulcerative colitis

· Tumour of intestines.

What are the types of anastomosis?

· End to end

· End to side

· Side to side

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BOWEL RESECTION Procedure 6

SMALL BOWEL RESECTION

Position of the patient

Suspine

Anaesthesia

General

Surgical steps

· Open the abdomen (paramedian) and gain entry to the peritoneal cavity.

· Identify the area to be resected.

· Divide mesentery to this area in the line of a shallow V, serially between ligatures.

· The apex of the V is towards the root of the mesentery.

· Divide bowel to be removed obliquely, removing more of antimesenteric border between non-crushing clamps.

· Approximate non-crushing clamps to appose the two cut ends of bowel.

· Carry out end-to-end anastomosis – an inner continuous layer of catgut and an outer continuous layer of silk.

· Approximate cut end of mesentery with interrupted sutures.

Instruments required

· Laparotomy set,1

· Allen intestinal clamps, 1 pair

When is an intestinal resection indicated?

The operation may be required in the following cases:

· In cases of strangulation and gangrene of bowel

· Volvulus

· Intussusception (irreducible)

· Tuberculosis of intestine with stricture

· Intestinal fistula

· Regional enteritis


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PROCEDURES 5 Jejunostomy

Jejunostomy

Objective

To provide a route for parenteral nutrition

Position

Supine

Anesthesia

General or local

Procedure

*locate a proximal loop of jejunum close to deudeno-jejunal flexure

 (DJ)

*Select a site 15-20 cm from DJ

*Through a stab wound on antimesenteric border introduce a carheter

 14F foley

*Close the opening around the catheter with catgut suture

*Bury the catheter in a short tunnel in the wall

*Bring out the catheter through a stab wound in the abdominal wall.

Instruments.

Gastro intestinal set

Foley 14 F

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GASTROSTOMY PROCEDURE 4

Gastrostomy

When is gastrostomy required ?

In cases of;

* Obstruction of oesophagus e.g.carcinoma to feed the patient and drain the stomach

* In cases of prolonged ileus or pacreatitis to keep stomach empty

Position of patient.

Supine.

Anaesthesia

General or local

Surgical steps

*Small midline incision

*Left anterior wall of stomach is held between two babcock's forceps midway between greater and lesser curvature

*Two purse string sutures from a selected site for entry.

*The stomach is incised at the selected point.A 14F foley's catheter is inserted through the opening and the two purse string tied around the catheter.

*The catheter is brought out through a stab on the anterior abdominal wall

*The stomach is anchored to the posterior peritoneum and rectus sheath.

Instruments used

*Laprotomy set

*Foley's catheter 14F
*Fine artery forceps 4

 

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