SURGICAL PROCEDURE 8 Appendectomy

     Appendectomy

Objective

•   In cases of acute or recurrent acute infection of the appendix or tumors of the appendix or carcinoid

•   Access to the organs in the right Iliac fossa

•   To excise the deceased appendix.

Position

Supine.

Anesthesia

General, epidural or spinal.

Procedure

1.  A right gridiron incision.

2.  Deliver cecum and trace a laenia to the base of the appendix.

3.  Mobilize appendix to its base by dividing mesoappendix serially between ligatures.

4.  Crush base of appendix with hemostat and tie crushed area with 20 silk suture.

5.  Cut above tie and remove appendix (send for histology).

6.  Invert appendix stump with a purse string suture on the cecum.

Instruments

•   Appendectomy set.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored unarchives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/providerengagement visit www.surgseminar.blogspot.com

www.drmmkapur.blogspot.com

Surgical PROCEDURE 7 GASTRIC RESECTION

Gastric Resection

Objective

To remove the stomach (Partial or Total) in case of:

•   Gastric ulcer; elective or emergency

•   Trauma

•   As part of other operations, e.g. pancreaticoduodesectomy.

Position

Supine - Midline incision.

Anesthesia

General.

Principles

a.  For ulcer disease 60-70% of the stomach is resected. The left gastric artery is ligated on the stomach. Omentum is not resected.

b.  For distal gastric cancers, the left gastric artery is ligated at its origin but short gastric arteries are preserved and 80% of stomach is resected.

c.  For gastric cancers involving the body or cardia, the entire stomach is resected with or the entire omentum. The left gastric artery is ligated at its origin and all short gastric arteries are ligated. The spleen may be removed in continuity to increase the radicality of the operation but is controversial. In b and c all draining lymph nodes are removed.

Procedure

1.  The stomach is mobilized after ligating the right gastric and gastroepiploic vessels at their origin.

2.  The duodenum is mobilized off the pancreas and divided.

3.  The distal end of the duodenum is closed in layers or stapled.

4.  The stomach is turned back to identify the left gastric artery is divided between ligatures.

5.  The stomach is resected and a gastrojejunostomy is fashioned.

6.  If a total gastrectomy is performed, then an esophago-jejunal “roux-en-y” anastomosis is done.

7.  The wound is closed in layers after draining the area of the duodenal stump.

Instruments

•   General set, 1

•   Gastrointestinal set, 1.

ANY question 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,please write to address above.

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

www.drmmkapur.blogspot.com

SURGICAL PROCEDURE 5 Jejunostomy

5.  Jejunostomy

Objective

To provide a route for enteral nutrition.

Position

Supine.

Anesthesia

General or Local.

Procedure

•   Locate a proximal loop of jejunum at the duodenojejunal flexure (D-J)

•   Select a site 15-20 cm from D-J flexure

•   Through a stab incision on the antimesenteric border, put in a catheter

•   Close the incision around stab using catgut sutures

•   Create a valve by burying the tube in a short tunnel in the jejunal wall. Take care not to narrow jejunal lumen

•   Bring out tube through a stab in anterior abdominal wall.

Instruments

•   Gastrointestinal set, 1

•   Catheter, 14 F.

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,please write to address above.

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

www.drmmkapur.bogspot.com

Surgical Procedure 4 Gastrostomy

4.  Gastrostomy

Objective

In case of:

•   Esophageal obstruction, e.g. carcinoma esophagus or cardiac to deliver nutrition.

•   Prolonged ileus or severe pancreatitis to provide gastric drainage (as an alternative to nasogastric intubation).

Position

Supine.

Anesthesia

General or local.

Procedure

•   Small midline incision.

•   Left arterior wall of stomach between two Babcock’s forceps midway between greater and lesser curvature.

•   Two purse string sutures at one and two cm radius from an imaginary center.

•   Incise the stomach at the centre and insert a 14 F Foley’s catheter and tie the two purse strings to produce an inkwell effect.

•   Bring out the tube through a stab in the anterior abdominal wall.

•   Anchor the stomach to peritoneum and rectus sheath using interrupted 20 silk sutures.

Instruments

•   Gastrointestinal set, 1

•   Foley’s catheter, 14 F.

Any questions be sent to drmmkapur@gmail.com

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

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/providerengagement visit www.surgseminar,bloodspot.com

www.drmmkapur.blogspot.com

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.

Any questions be sent to drmmkapur@gmail.com

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

Visitors that follow may post contributions to the site please write to address above.

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

www.drmmkapur.blogspot.com