- Intestinal stomas are surgically created openings of the small or large intestine onto the abdominal wall. There are three main types: colostomy, ileostomy, and loop stoma.
- Complications include prolapse, herniation, stenosis, dermatitis from effluent, and obstruction. Dietary advice focuses on reducing gas, bulk and odorous foods. Management involves properly attaching collection bags and monitoring for complications.
Whipple's procedure - Indications, Steps, ComplicationsVikas V
The document describes the Whipple procedure, which was first performed by Dr. Allen Whipple in 1935. It involves removing the head of the pancreas, part of the small intestine, the gallbladder, and bile duct. The original procedure was done in two stages but is now typically done in one stage. The document outlines the key steps of the modern Whipple procedure, including mobilizing tissues, dividing vessels, transecting organs, and reconstructing the digestive and biliary systems with anastomoses. Vascular resection of veins like the splenic vein may sometimes be required as well.
An ostomy is a surgically created opening in the intestine that allows for waste to exit the body into an external bag. There are two main types - an ileostomy, which is created from the small intestine, and a colostomy, which is created from the large intestine. An ostomy may be temporary or permanent and is usually required due to conditions like cancer, IBD, or injury. Attaching the external bag securely is important to prevent complications. Diet and lifestyle adjustments are also needed after an ostomy is created.
A nephrectomy is a surgical procedure to remove a kidney. There are several types including simple, partial, and radical nephrectomies. A surgeon must have knowledge of renal anatomy and vasculature. Approaches can be open, laparoscopic, or robotic. Key steps include mobilizing the kidney, isolating and ligating the renal vessels, and closing fascial layers. Complications include bleeding, fistula, and loss of renal function.
An intestinal stoma is an artificial opening in the abdominal wall that connects the intestinal tract to the outside of the body. There are different types of stomas including ileostomies, colostomies, and urostomies. Ileostomies divert small intestine contents and have a liquid effluent that is discharged continuously. Colostomies divert large intestine contents and have solid, intermittent effluent. Stomas can be temporary or permanent depending on the clinical situation and are constructed in different ways including as an end stoma or loop stoma. Proper stoma care and use of appliances is important for managing stomas.
This document discusses splenectomy, the surgical removal of the spleen. It defines splenectomy and outlines the relevant anatomy of the spleen. The document then discusses the indications for splenectomy, including trauma, hematological disorders, tumors, and vascular abnormalities. It covers the preoperative preparation, anesthesia, positioning, exposure, closure, and postoperative management of splenectomy. Finally, it lists some potential complications of splenectomy.
This document describes the open cholecystectomy procedure. It indicates that open cholecystectomy is performed to treat conditions like cholecystitis, cholelithiasis, and choledocholithiasis. It outlines the patient preparation, incision type (typically a right subcostal incision), and technique which involves dissecting and ligating/clipping the cystic duct and artery before removing the gallbladder. Potential complications of the open procedure include bleeding, infection, and bile leaks or common bile duct injuries.
The document outlines the procedure for an appendectomy. It discusses the definition, indications, types of procedure, pre-operative preparation including investigations and positioning of the patient. It describes the exposure and steps of the procedure in detail. It discusses post-operative management and potential complications. Key steps involve delivering the cecum, identifying and ligating the appendix, and closing the abdominal wall.
- Intestinal stomas are surgically created openings of the small or large intestine onto the abdominal wall. There are three main types: colostomy, ileostomy, and loop stoma.
- Complications include prolapse, herniation, stenosis, dermatitis from effluent, and obstruction. Dietary advice focuses on reducing gas, bulk and odorous foods. Management involves properly attaching collection bags and monitoring for complications.
Whipple's procedure - Indications, Steps, ComplicationsVikas V
The document describes the Whipple procedure, which was first performed by Dr. Allen Whipple in 1935. It involves removing the head of the pancreas, part of the small intestine, the gallbladder, and bile duct. The original procedure was done in two stages but is now typically done in one stage. The document outlines the key steps of the modern Whipple procedure, including mobilizing tissues, dividing vessels, transecting organs, and reconstructing the digestive and biliary systems with anastomoses. Vascular resection of veins like the splenic vein may sometimes be required as well.
An ostomy is a surgically created opening in the intestine that allows for waste to exit the body into an external bag. There are two main types - an ileostomy, which is created from the small intestine, and a colostomy, which is created from the large intestine. An ostomy may be temporary or permanent and is usually required due to conditions like cancer, IBD, or injury. Attaching the external bag securely is important to prevent complications. Diet and lifestyle adjustments are also needed after an ostomy is created.
A nephrectomy is a surgical procedure to remove a kidney. There are several types including simple, partial, and radical nephrectomies. A surgeon must have knowledge of renal anatomy and vasculature. Approaches can be open, laparoscopic, or robotic. Key steps include mobilizing the kidney, isolating and ligating the renal vessels, and closing fascial layers. Complications include bleeding, fistula, and loss of renal function.
An intestinal stoma is an artificial opening in the abdominal wall that connects the intestinal tract to the outside of the body. There are different types of stomas including ileostomies, colostomies, and urostomies. Ileostomies divert small intestine contents and have a liquid effluent that is discharged continuously. Colostomies divert large intestine contents and have solid, intermittent effluent. Stomas can be temporary or permanent depending on the clinical situation and are constructed in different ways including as an end stoma or loop stoma. Proper stoma care and use of appliances is important for managing stomas.
This document discusses splenectomy, the surgical removal of the spleen. It defines splenectomy and outlines the relevant anatomy of the spleen. The document then discusses the indications for splenectomy, including trauma, hematological disorders, tumors, and vascular abnormalities. It covers the preoperative preparation, anesthesia, positioning, exposure, closure, and postoperative management of splenectomy. Finally, it lists some potential complications of splenectomy.
This document describes the open cholecystectomy procedure. It indicates that open cholecystectomy is performed to treat conditions like cholecystitis, cholelithiasis, and choledocholithiasis. It outlines the patient preparation, incision type (typically a right subcostal incision), and technique which involves dissecting and ligating/clipping the cystic duct and artery before removing the gallbladder. Potential complications of the open procedure include bleeding, infection, and bile leaks or common bile duct injuries.
The document outlines the procedure for an appendectomy. It discusses the definition, indications, types of procedure, pre-operative preparation including investigations and positioning of the patient. It describes the exposure and steps of the procedure in detail. It discusses post-operative management and potential complications. Key steps involve delivering the cecum, identifying and ligating the appendix, and closing the abdominal wall.
1) Incisional hernias occur when the abdominal muscles and fascia separate, allowing organs or fatty tissue to protrude through weaknesses in the abdominal wall. They commonly form around surgical incision sites.
2) Risk factors include obesity, pregnancy, ascites, procedures that increase abdominal pressure, and surgical factors like wound infection or improper closure technique.
3) Clinical features include swelling, pain, and visible or palpable bulging that increases with straining. Diagnosis is usually made through physical exam.
4) Treatment involves repairing the defect through primary closure for small defects or use of prosthetic mesh for larger defects to reinforce the abdominal wall. Preventing postoperative complications and weight control can help
Choledocholithiasis refers to stones in the common bile duct. Stones can be primary, forming directly in the bile duct, or secondary, originating from the gallbladder. Clinical features include biliary colic, jaundice, fever, and complications like cholangitis. Investigations include ultrasound, MRCP, CT, and ERCP. Treatment involves ERCP with sphincterotomy and stone extraction, or open exploration during cholecystectomy. For retained stones, techniques include T-tube flushing or reoperation with transduodenal sphincteroplasty or choledochojejunostomy.
Surgical treatment for peptic ulcer diseaseBashir BnYunus
This document discusses surgical treatments for peptic ulcer disease. It outlines relevant anatomy and physiology, classifications of PUD, indications for surgery, and various surgical options including vagotomy, gastrectomy, Graham's omental patch, and suture ligation of the gastroduodenal artery. Complications are also reviewed. The prognosis is generally satisfactory with operative procedures, though complications can include bleeding, leakage, obstruction, and recurrent ulceration. Delayed treatment increases morbidity and mortality risks.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Chronic pancreatitis is a progressive inflammatory condition of the pancreas characterized by irreversible morphological changes and loss of function. It is most commonly caused by long term heavy alcohol use. Symptoms include recurrent abdominal pain, steatorrhea due to exocrine insufficiency, and diabetes mellitus due to endocrine insufficiency. Diagnosis involves functional tests like fecal elastase and imaging modalities like CT, MRI, ERCP and EUS which demonstrate findings of pancreatic duct abnormalities, parenchymal changes and calcifications.
This document provides an overview of inguinal hernias. It defines a hernia as the protrusion of an organ through a weakness in the muscle wall. It then discusses the epidemiology, types, anatomy, etiology, pathogenesis, signs and symptoms, diagnosis, treatment and complications of inguinal hernias. The treatment options covered are herniotomy, herniorrhaphy, and laparoscopic repair techniques like the Lichtenstein method. The prognosis is typically good, though there is a small risk of recurrence.
1. An umbilical hernia is a protrusion of abdominal contents through the abdominal wall near the umbilicus.
2. It can be congenital, due to incomplete closure of the umbilical ring, or acquired later in life due to risk factors like obesity, pregnancy, or ascites.
3. Physical exam reveals a soft, reducible mass at the umbilicus that increases in size with straining; complications include incarceration or strangulation which require surgery.
This document provides information on different types of gastric resection surgeries including wedge resection, distal gastrectomy, total gastrectomy, and subtotal gastrectomy. It describes the anatomy of the stomach and surrounding structures. It details the surgical techniques for each type of resection including mobilization, resection, and reconstruction. Common indications for gastric resections are described as peptic ulcer disease and gastric tumors. The history of developments in gastric surgery techniques from the late 19th century onward is also summarized.
This document discusses obstructive jaundice, providing definitions, pathophysiology, effects on various body systems, etiology, history and examination findings, laboratory investigations, imaging modalities, and causes of biliary obstruction. It defines obstructive jaundice as a failure of bile to reach the intestine due to mechanical obstruction. Pathophysiological changes include bile duct dilation, hepatic fibrosis, and portal hypertension. Causes include gallstones, strictures, tumors, and congenital anomalies. A thorough history, physical exam, and lab tests can localize the level and cause of obstruction, while imaging modalities like ultrasound and MRCP can identify and characterize obstructive lesions.
The document discusses gastric outlet obstruction (GOO), which refers to any mechanical impediment to gastric emptying. It can be caused by benign or malignant conditions. Common benign causes include peptic ulcer disease and gastric polyps, while pancreatic cancer is a frequent malignant cause. Symptoms include vomiting, weight loss, and dehydration. Diagnosis involves imaging like barium studies and endoscopy. Treatment of GOO focuses on rehydration, nutritional support, and correcting electrolyte imbalances. Surgical intervention may be needed for persistent or malignant obstructions.
Loop ileostomy or loop colostomy can be used to divert fecal streams and protect colorectal anastomoses based on indications from various diseases and procedures. Complications occur in 21-70% of cases, relating to the stoma, peristomal skin, or systemic issues. Guidelines recommend techniques to decrease complications like laparoscopy, protruding stomas, and mesh reinforcement. While some studies found ileostomy had fewer hernias and prolapses, meta-analyses show no clear preference between ileostomy and colostomy. Alternative options like ghost ileostomy or transanal decompression tubes may help avoid stomas in some cases.
An exploratory laparotomy is a surgical procedure where the abdomen is opened to examine the internal organs. It is performed under general anesthesia through an upper midline incision. Indications include trauma, infections, malignancy, complications of other procedures, and removal of foreign bodies. During the procedure, the surgeon examines the abdominal organs and treats any issues found. Potential complications include ileus, infection, hernia, and adhesive obstruction.
This document discusses hemorrhoidectomy, which is the surgical excision of hemorrhoids. It defines hemorrhoidectomy and lists its indications. The types of hemorrhoidectomy procedures are open, closed, and stapled. Preoperative preparation includes a high fiber diet, stool softeners, and antibiotics. The procedure involves excising hemorrhoids using spinal or general anesthesia and leaving tissue bridges between excised areas. Post-operative management includes analgesia, laxatives, and sitz baths. Complications can include bleeding, urinary retention, impaction, stenosis, fissures, tags, recurrence, and incontinence.
OPEN CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #opencholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy and Modified Radical Mastectomy.
• In this video today, I have discussed Open Cholecystectomy.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
This document discusses prostatectomy procedures including simple and radical prostatectomy. Simple prostatectomy involves removing part of the prostate for benign conditions, while radical prostatectomy removes the entire prostate and surrounding tissues for prostate cancer. The document describes different approaches for radical prostatectomy including radical perineal, supra pubic, and retro pubic. Key instruments used in prostatectomy are also listed such as retractors, forceps, scissors, and hemoclip appliers.
This document provides information about carcinoma of the esophagus, including its epidemiology, risk factors, pathological classification, clinical features, investigations, diagnosis and staging, and treatment. Carcinoma of the esophagus is most common in China, South Africa, and parts of India. It typically presents with dysphagia. Investigations include endoscopy with biopsy, imaging like CT and PET scans, and endoscopic ultrasound. Treatment depends on the stage, with surgery or chemoradiation used for early-stage or locally advanced carcinoma, and palliative approaches for metastatic disease.
Open right hemicolectomy is performed to treat malignant tumors, polyps, and other conditions in the ileocecal region, ascending colon, and hepatic flexure. The procedure involves mobilizing the right colon, ligating blood vessels, resecting the involved bowel segments, and creating an ileocolic or ileotransverse anastomosis. Key steps include careful dissection to avoid injury to nearby structures like the duodenum and ureter, and ensuring a well-vascularized, tension-free anastomosis to minimize risks of leakage. Post-operative care focuses on early ambulation and advancing diet based on progress.
Types, Investigation, complication and treatment of Incisional herniaimraxid
This document discusses the anatomy of the abdominal wall and incisional hernias. It notes that incisional hernias occur through weak points in previous abdominal scars from surgery. Factors that can predispose to incisional hernias include vertical or midline scars, emergency surgeries, poor wound healing, increased abdominal pressure from coughing or straining, and underlying conditions like obesity, malnutrition or liver disease. Clinical features may include a swelling or bulge that increases with coughing along with pain. Treatment involves surgical repair of the hernia defect.
This document describes the procedure for a right hemicolectomy. It involves making a midline abdominal incision, mobilizing the terminal ileum and cecum, ligating and dividing the ileocolic, right colic, and middle colic vessels, removing the ascending colon and portions of the ileum and transverse colon. An end-to-side anastomosis is then performed between the ileum and transverse colon using interrupted sutures in two layers to reconnect the bowel.
A modified radical mastectomy removes the breast tissue, nipple, skin, and lymph nodes in levels I and II of the axilla, while the Patey modification also removes the pectoralis minor muscle to access level III lymph nodes; complications can include lymphedema if radiation is also used post-surgery or seromas which are usually drained with needles though drains placed during surgery help prevent them. The procedure involves dissecting the breast from the chest wall and axilla while preserving key nerves and blood vessels.
This document provides information on principles of gastrectomy, including:
- A brief history of gastrectomy procedures from the early 19th century to modern developments.
- Details on the anatomy, blood supply, lymph drainage of the stomach as relevant to gastrectomy.
- Descriptions of different types and techniques of gastrectomy for treating conditions like cancer, ulcers, and obesity.
- Information on pre-operative preparation, surgical techniques for different procedures like Billroth I and II reconstructions, and post-operative care and complications.
1) Incisional hernias occur when the abdominal muscles and fascia separate, allowing organs or fatty tissue to protrude through weaknesses in the abdominal wall. They commonly form around surgical incision sites.
2) Risk factors include obesity, pregnancy, ascites, procedures that increase abdominal pressure, and surgical factors like wound infection or improper closure technique.
3) Clinical features include swelling, pain, and visible or palpable bulging that increases with straining. Diagnosis is usually made through physical exam.
4) Treatment involves repairing the defect through primary closure for small defects or use of prosthetic mesh for larger defects to reinforce the abdominal wall. Preventing postoperative complications and weight control can help
Choledocholithiasis refers to stones in the common bile duct. Stones can be primary, forming directly in the bile duct, or secondary, originating from the gallbladder. Clinical features include biliary colic, jaundice, fever, and complications like cholangitis. Investigations include ultrasound, MRCP, CT, and ERCP. Treatment involves ERCP with sphincterotomy and stone extraction, or open exploration during cholecystectomy. For retained stones, techniques include T-tube flushing or reoperation with transduodenal sphincteroplasty or choledochojejunostomy.
Surgical treatment for peptic ulcer diseaseBashir BnYunus
This document discusses surgical treatments for peptic ulcer disease. It outlines relevant anatomy and physiology, classifications of PUD, indications for surgery, and various surgical options including vagotomy, gastrectomy, Graham's omental patch, and suture ligation of the gastroduodenal artery. Complications are also reviewed. The prognosis is generally satisfactory with operative procedures, though complications can include bleeding, leakage, obstruction, and recurrent ulceration. Delayed treatment increases morbidity and mortality risks.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Chronic pancreatitis is a progressive inflammatory condition of the pancreas characterized by irreversible morphological changes and loss of function. It is most commonly caused by long term heavy alcohol use. Symptoms include recurrent abdominal pain, steatorrhea due to exocrine insufficiency, and diabetes mellitus due to endocrine insufficiency. Diagnosis involves functional tests like fecal elastase and imaging modalities like CT, MRI, ERCP and EUS which demonstrate findings of pancreatic duct abnormalities, parenchymal changes and calcifications.
This document provides an overview of inguinal hernias. It defines a hernia as the protrusion of an organ through a weakness in the muscle wall. It then discusses the epidemiology, types, anatomy, etiology, pathogenesis, signs and symptoms, diagnosis, treatment and complications of inguinal hernias. The treatment options covered are herniotomy, herniorrhaphy, and laparoscopic repair techniques like the Lichtenstein method. The prognosis is typically good, though there is a small risk of recurrence.
1. An umbilical hernia is a protrusion of abdominal contents through the abdominal wall near the umbilicus.
2. It can be congenital, due to incomplete closure of the umbilical ring, or acquired later in life due to risk factors like obesity, pregnancy, or ascites.
3. Physical exam reveals a soft, reducible mass at the umbilicus that increases in size with straining; complications include incarceration or strangulation which require surgery.
This document provides information on different types of gastric resection surgeries including wedge resection, distal gastrectomy, total gastrectomy, and subtotal gastrectomy. It describes the anatomy of the stomach and surrounding structures. It details the surgical techniques for each type of resection including mobilization, resection, and reconstruction. Common indications for gastric resections are described as peptic ulcer disease and gastric tumors. The history of developments in gastric surgery techniques from the late 19th century onward is also summarized.
This document discusses obstructive jaundice, providing definitions, pathophysiology, effects on various body systems, etiology, history and examination findings, laboratory investigations, imaging modalities, and causes of biliary obstruction. It defines obstructive jaundice as a failure of bile to reach the intestine due to mechanical obstruction. Pathophysiological changes include bile duct dilation, hepatic fibrosis, and portal hypertension. Causes include gallstones, strictures, tumors, and congenital anomalies. A thorough history, physical exam, and lab tests can localize the level and cause of obstruction, while imaging modalities like ultrasound and MRCP can identify and characterize obstructive lesions.
The document discusses gastric outlet obstruction (GOO), which refers to any mechanical impediment to gastric emptying. It can be caused by benign or malignant conditions. Common benign causes include peptic ulcer disease and gastric polyps, while pancreatic cancer is a frequent malignant cause. Symptoms include vomiting, weight loss, and dehydration. Diagnosis involves imaging like barium studies and endoscopy. Treatment of GOO focuses on rehydration, nutritional support, and correcting electrolyte imbalances. Surgical intervention may be needed for persistent or malignant obstructions.
Loop ileostomy or loop colostomy can be used to divert fecal streams and protect colorectal anastomoses based on indications from various diseases and procedures. Complications occur in 21-70% of cases, relating to the stoma, peristomal skin, or systemic issues. Guidelines recommend techniques to decrease complications like laparoscopy, protruding stomas, and mesh reinforcement. While some studies found ileostomy had fewer hernias and prolapses, meta-analyses show no clear preference between ileostomy and colostomy. Alternative options like ghost ileostomy or transanal decompression tubes may help avoid stomas in some cases.
An exploratory laparotomy is a surgical procedure where the abdomen is opened to examine the internal organs. It is performed under general anesthesia through an upper midline incision. Indications include trauma, infections, malignancy, complications of other procedures, and removal of foreign bodies. During the procedure, the surgeon examines the abdominal organs and treats any issues found. Potential complications include ileus, infection, hernia, and adhesive obstruction.
This document discusses hemorrhoidectomy, which is the surgical excision of hemorrhoids. It defines hemorrhoidectomy and lists its indications. The types of hemorrhoidectomy procedures are open, closed, and stapled. Preoperative preparation includes a high fiber diet, stool softeners, and antibiotics. The procedure involves excising hemorrhoids using spinal or general anesthesia and leaving tissue bridges between excised areas. Post-operative management includes analgesia, laxatives, and sitz baths. Complications can include bleeding, urinary retention, impaction, stenosis, fissures, tags, recurrence, and incontinence.
OPEN CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #opencholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy and Modified Radical Mastectomy.
• In this video today, I have discussed Open Cholecystectomy.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
This document discusses prostatectomy procedures including simple and radical prostatectomy. Simple prostatectomy involves removing part of the prostate for benign conditions, while radical prostatectomy removes the entire prostate and surrounding tissues for prostate cancer. The document describes different approaches for radical prostatectomy including radical perineal, supra pubic, and retro pubic. Key instruments used in prostatectomy are also listed such as retractors, forceps, scissors, and hemoclip appliers.
This document provides information about carcinoma of the esophagus, including its epidemiology, risk factors, pathological classification, clinical features, investigations, diagnosis and staging, and treatment. Carcinoma of the esophagus is most common in China, South Africa, and parts of India. It typically presents with dysphagia. Investigations include endoscopy with biopsy, imaging like CT and PET scans, and endoscopic ultrasound. Treatment depends on the stage, with surgery or chemoradiation used for early-stage or locally advanced carcinoma, and palliative approaches for metastatic disease.
Open right hemicolectomy is performed to treat malignant tumors, polyps, and other conditions in the ileocecal region, ascending colon, and hepatic flexure. The procedure involves mobilizing the right colon, ligating blood vessels, resecting the involved bowel segments, and creating an ileocolic or ileotransverse anastomosis. Key steps include careful dissection to avoid injury to nearby structures like the duodenum and ureter, and ensuring a well-vascularized, tension-free anastomosis to minimize risks of leakage. Post-operative care focuses on early ambulation and advancing diet based on progress.
Types, Investigation, complication and treatment of Incisional herniaimraxid
This document discusses the anatomy of the abdominal wall and incisional hernias. It notes that incisional hernias occur through weak points in previous abdominal scars from surgery. Factors that can predispose to incisional hernias include vertical or midline scars, emergency surgeries, poor wound healing, increased abdominal pressure from coughing or straining, and underlying conditions like obesity, malnutrition or liver disease. Clinical features may include a swelling or bulge that increases with coughing along with pain. Treatment involves surgical repair of the hernia defect.
This document describes the procedure for a right hemicolectomy. It involves making a midline abdominal incision, mobilizing the terminal ileum and cecum, ligating and dividing the ileocolic, right colic, and middle colic vessels, removing the ascending colon and portions of the ileum and transverse colon. An end-to-side anastomosis is then performed between the ileum and transverse colon using interrupted sutures in two layers to reconnect the bowel.
A modified radical mastectomy removes the breast tissue, nipple, skin, and lymph nodes in levels I and II of the axilla, while the Patey modification also removes the pectoralis minor muscle to access level III lymph nodes; complications can include lymphedema if radiation is also used post-surgery or seromas which are usually drained with needles though drains placed during surgery help prevent them. The procedure involves dissecting the breast from the chest wall and axilla while preserving key nerves and blood vessels.
This document provides information on principles of gastrectomy, including:
- A brief history of gastrectomy procedures from the early 19th century to modern developments.
- Details on the anatomy, blood supply, lymph drainage of the stomach as relevant to gastrectomy.
- Descriptions of different types and techniques of gastrectomy for treating conditions like cancer, ulcers, and obesity.
- Information on pre-operative preparation, surgical techniques for different procedures like Billroth I and II reconstructions, and post-operative care and complications.
gastric resection, reconstruction and post gastrectomy syndromessanyal1981
discussion regarding history of gastrectomy, types of gastrectomy, billroth I, billroth II and roux en y gastrojejunostomy........discussion of post gastrectomy syndromes
This document discusses various gastrointestinal surgical procedures in veterinary medicine. It covers topics such as gastric and abomasal ulcers, gastric dilatation and torsion, gastric neoplasms, bloat, and rumen fistulation and rumenotomy. Diagnostic techniques including radiography, endoscopy, and ultrasound are mentioned. Surgical treatments including gastrectomy, pyloroplasty, and rumenostomy are summarized. The document provides an overview of common gastrointestinal surgical conditions and procedures in large animals.
- Perforation of the gastrointestinal tract can occur due to various causes like perforated ulcers, penetrating injuries, or ischemic bowel. Signs include severe abdominal pain, fever, and tenderness.
- Diagnosis is suggested by imaging showing free air or fluid in the abdomen. Treatment requires emergency surgery to repair any perforations followed by intensive care and broad-spectrum antibiotics to treat peritonitis.
- Surgical management involves thorough irrigation and drainage of the abdominal cavity followed by resection of non-viable bowel and primary anastomosis or stoma formation as needed. Close postoperative monitoring in the ICU is important to support organ function and detect any complications.
This document discusses gastrointestinal procedures including gastrostomy, vagotomy, and gastrectomy. It describes the relevant anatomy and physiology of the stomach. Gastrostomy involves placing a feeding tube into the stomach and can be done openly or percutaneously. Vagotomy involves dividing the vagus nerves to reduce acid secretion and is often combined with drainage procedures. Gastrectomy removes part of the stomach, with options including Billroth I and II procedures. Complications of these surgeries include bleeding, leakage, obstruction, and nutritional deficiencies. Overall, these procedures provide satisfactory relief of symptoms in 80% of patients.
APD complications and surgical management.pptxNartMood
This document discusses acid peptic disease and its complications including perforation. It defines acid peptic disease and lists its types and complications. Perforated peptic ulcer is described in detail, including its epidemiology, clinical features, diagnosis, and management through surgery, peritoneal lavage, and postoperative care. Conservative treatment is also discussed. Other complications like bleeding and their long term sequelae are mentioned.
The document provides information about barium meal examinations, including indications, contraindications, preparation, techniques, and findings. It describes single contrast and double contrast barium meal studies. Key points include:
- Barium meal examines the esophagus, stomach, duodenum and proximal jejunum through oral administration of barium contrast.
- Indications include abdominal pain, weight loss, vomiting, anemia, and suspected masses or malignancies.
- Contraindications include suspected perforation and recent biopsies.
- Single contrast visually assesses anatomy while double contrast enhances mucosal details through added gas contrast.
- Findings are evaluated for abnormalities like ulcers,
Imafing in bariatric surgery and complications farhaFarha Naz
This document discusses various bariatric surgery procedures and their associated imaging findings. It describes laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy procedures. Common complications discussed include band slippage, erosion, or leakage with LAGB and anastomotic leaks or strictures with RYGB. With sleeve gastrectomy, dilatation, leaks, or stenosis may occur. The radiologist plays a key role in preoperative planning and postoperative monitoring for complications on imaging studies.
This document discusses the embryology and anatomy of the stomach. It provides the following key points:
1. During embryonic development, the stomach rotates along its longitudinal and anteroposterior axes, causing its final adult position with the cardiac portion on the left and pylorus on the right.
2. The adult stomach is located in the left upper quadrant and extends across the midline, with the greater curvature forming the anterior wall and lesser curvature the posterior wall.
3. Radiological techniques for examining the stomach include barium studies, CT, MRI, and virtual endoscopy, which allow evaluation of stomach morphology, layers, and relationships to surrounding organs.
This document discusses the management of abdominal vascular injuries. It covers the epidemiology, anatomy, presentation, investigations, surgical approaches, challenges, and complications of abdominal vascular injuries. Resuscitation and damage control techniques are emphasized. Exposure and control of the aorta, inferior vena cava, and iliac vessels are described in detail. Primary repair or ligation are the main repair options, with endovascular techniques also playing a selective role. Mortality rates are high and prompt diagnosis and management are critical due to the risk of exsanguinating hemorrhage.
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Affections of cecum, colon & rectum (Veterinary)girjesh upmanyu
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This document discusses the radiological anatomy and pathologies of the stomach. It begins with an overview of examination techniques including endoscopy, barium meal, CT, and endoscopic ultrasound. It then describes the anatomy of the stomach and surrounding structures. The main pathologies discussed are gastritis, peptic ulcer disease, neoplasms, and congenital anomalies. For inflammatory conditions like gastritis and peptic ulcers, the document outlines imaging findings and distinguishing features of different types. It similarly discusses imaging features that help differentiate benign from malignant ulcers.
Veterinary Gastrointestinal surgery Part-III Rekha Pathak
The document discusses various gastrointestinal surgical procedures in veterinary medicine, including procedures for treating gastric neoplasms, bloat, and rumen-related issues. Techniques like partial gastrectomy, antrectomy, rumen fistulation, rumenotomy, and rumenostomy are described. Complications from various conditions and the signs, diagnosis, and treatment approaches are also outlined.
The document provides information about right hepatectomy surgery:
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Malignant bowel obstruction is caused by luminal narrowing of the small or large bowel due to metastatic cancer. The most common primary cancers are colorectal, ovarian, breast, and melanoma. Treatment aims to relieve symptoms like nausea, vomiting, and pain through non-surgical means if possible, including octreotide, opioids, antiemetics, and stenting. Surgery is considered for partial obstructions but has risks. The goal is palliation to improve quality of life rather than cure.
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This document provides an overview of the management of acute pancreatitis. It defines acute pancreatitis as the inflammation of the pancreas often associated with pancreatic duct dilation. It discusses the epidemiology, etiology, pathogenesis, clinical forms, investigations, risk assessment, treatment and prognosis of acute pancreatitis. The management involves resuscitation, assessing severity, treating any underlying causes, and monitoring for complications which can include pancreatic necrosis, infection and multi-organ failure. Severity is assessed using scoring systems like Ranson's criteria or CT severity index to determine prognosis and guide management.
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- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. OUTLINE
• INTRODUCTION
• HISTORY
• ANATOMY OF THE STOMACH
• TYPES OF GASTRECTOMY
• INDICATION
• PREOPERATIVE PREPARATION
• PROCEDURE
• – SUBTOTAL GASTRECTOMY
• - BILLROTH II
• COMPLICATIONS
• REFERENCES
3. INTRODCTION
• Gastrectomy is the surgical removal of part or the entire stomach.
• The earliest recorded operations on the stomach were performed for
penetrating injuries. Knife from the stomach of a knife thrower 1602
• Late 1800s: Experimental studies by Billroth confirmed the feasibility
of removing the pylorus.
• The last 20 years of the nineteenth century saw the introduction of
many gastric operations, some of which were to become established
and modified during the ensuing years.
4. • Billroth 1881: Performed the first successful pylorectomy –
Duodenum anastomosed to the lesser curvature of the stomach and
the greater curvature oversewn.
• Billroth 1885: Resection of a large pyloric carcinoma, using an anterior
gastrojejunostomy
• Several modifications of where seen over time
5. ANATOMY
PARTS OF THE STOMACH
It is usually J shaped and
located in the left upper
quadrant and epigastrium, and
its distal part can extend to the
level of the umbilicus.
The stomach is divided into;
Fundus,
Body,
Antrum
Pylorus.
6.
7.
8. ANATOMY
TYPES OF CELLS;
• Secretory epithelial cells cover the surface of the stomach;
• Mucous cells: secrete an alkaline mucus that protects the epithelium against
shear stress and acid.
• Parietal cells: secrete hydrochloric acid and intrinsic factor
• Chief cells: secrete pepsinogen, a proteolytic enzyme.
• G cells: secrete the hormone gastrin.
• Enterochromaffin cells- histamine
• D cells somatostatin
9. Arterial blood supply:
COELIAC TRUNK; 3Branches
Left Gastric Artery;
Supplies the cardia of the stomach and distal
esophagus
Splenic Artery;
Gives rise to 2 branches which help supply the
greater curvature of the stomach;
Left Gastroepiploic, Short Gastric Arteries
Common Hepatic ;
2 major branches Right Gastric- supplies a portion of
the lesser curvature
Gastroduodenal artery-Gives rise to Right
Gastroepiploic artery Helps supply greater curvature
in conjunction with Left Gastroepiploic Artery
12. ANATOMY
• LYHMPHATIC DRAINAGE
• The lymphatics of the stomach ultimately drain into the coeliac group.
• Zones
• Nodes
• Stations in D1-D4 resection
13. The lymphatics drainage
are grouped into 3 zones
Zone 1 drain via
Left gastric nodes
Right gastric nodes
Zone 2
Gastroepiploic
Suprapyloric
Subpyloric
Zone 3
Splenic, short gastric
Suprapancreatic
14. N1 – First tier – nodes within 3cm
from the primary tumour and are
station 1-6
1. Right cardiac
2. Left cardiac
3. Nodes along the lesser curvature
4. Nodes along the greater curvature
a.Along short gastric -4sa
b. Along left gastroepiploic 4sb
c. Along right gastroepiploic 4sc
5. Suprapyloric nodes
6. Subpyloric nodes
15. N2- Second tier nodes: Nodes
in main and intermediate
arterial trunk stations 7-11
7. Along left gastric artery
8. Along common hepatic artery
9. Along coeliac axis
10. At splenic hilum
11. Along splenic artery
16. N3 - Third tier nodes: Nodes at
stations 12-18 (para-aortic
and above)
12. At hepatoduodenal
ligament
13. Retroduodenal lymph
nodes
14. At root of mesentery
15. Around middle colic artery
16. Para-aortic nodes
17. Around lower oesophagus
18. Supradiaphragmatic
17. • D1—involvement of group I lymph nodes.
• D2—involvement of group I and II lymph nodes.
• D3—involvement of group I, II and III lymph nodes.
• D4—involvement of group I, II, III and para-aortic nodes
• D4 is not commonly advocated. It is removal of stations 1-18.
18. TYPES OF GASTRECTOMY
• Base on the amount of stomach removed
• Total
• Near total >90%
• Subtotal 80-90 %
• Partial 65-75 %
• Hemigastrectomy 50 %
• Antrectomy (distal gastrectomy ) 35-50%
• Base on the method of reconstruction
• Billroth I
• Billroth II
• Roux en Y
19. BILLROTH 1
• Partial gastrectomy with gastro-duodenostomy. It is the most
physiologic type of gastric resection, since it restores normal
continuity.
20. Variations of Billroth I
A. Billroth (1881)
B. Billroth (1881)
C. Kocher (1890)
D. Kutscha-Lissberg (1925)
E. V. Haberer (1920)
F. V. Haberer (1920), Finney (1923)
G. Winkelbauer (1927)
H. Schoemaker (1911)
I. Harkins, Nyhus (1960
25. • Extent of lymphadenectomy
• D0 – incomplete D1
• D1; 1-6
• D2; 7-11
• D3; 12-14
• D4; 15, 16
• BASE ON THE RESECTION MARGIN
• R0
• R1
• R2
• BASE ON TECHNIQUE
• OPEN OR LAPAROSCOPIC
26. INDICATION
• PEPTIC ULCER DISEASE
• Intractable PUD
• Recurrent bleeding – for low risk patients
• Cicatrization- GOO
• Gastric ulcer type II and III
• Partial gastrectomy combine with vagotomy has shown less mortility disturbance
and marginal ulcers.
• TUMOURS; benign tumour of antrum, gastric cancer
• OBESITY- sleeve gastrectomy
• TRAUMA;
• STRICTURE
27. Choice for procedure
• Total gastrectomy
• indicated when the extent, or
• location, of the primary tumour is such that adequate margins
• of resection (i.e. 4–6 cm) are not possible by a subtotal
• gastrectomy. proximal gastric
• tumours and extensive lesions, including linitis plastica.
• Subtotal gastrectomy
• particularly suitable for
• small gastric tumours involving the pylorus and distal third
• of the stomach.
• Billroth I;
• benign gastric ulcer (proved by endoscopic biopsy),
• benign tumour of the distal stomach,
• trauma to distal stomach,
• recurrent or bleeding duodenal ulcer,
• if pyloroplasty is not feasible.
• Billroth II
• Gastric ulcer where Billroth I is not possible
• carcinoma pylorus and antrum as a radical or palliative procedure;
• recurrent ulcers;
• Trauma to distal stomach and duodenum.
28. • NB;
• In carcinoma distal stomach, Billroth I anastomosis is usually not done
as recurrence in bed when it occurs will cause obstruction due to
encasement of the relapsed (local) tumour;
29. • The advantage of a Billroth I gastrectomy over a Billroth II procedure
• maintenance of the physiological and anatomical gastroduodenal pathway.
Thus, it offers a lower incidence of post-gastrectomy syndromes.
• minimal disturbance of pancreatic function, and a
• possible lower incidence of late development of carcinoma in the stomach
remnant.
30. PREOPERATIVE PREPARATION
• History – symptoms, risk factor, co-morbidity
• Examination; Epigastric mass, features of advance disease
• UPPER GI ENDOSCOPY AND BIOPSY
• Abdominal CT scan; adjacent structures and liver metastesis
• ENDOLUMINAL USS; infiltration and local nodal involvement
• LAPAROSCOPY is useful for determining tumour spread in the peritoneal cavity and assessing any
fixation of the tumour to surrounding organs.
• Chest X-ray
• ECG, echo
• Optimize derangement; dehydration, dyselectrolytemia, anaemia, GXM, nutritional rehab
• CONSENT
• Preoperative antibiotics
31. PROCEDURE – SUBTOTAL GASTRECTOMY
• For small cancers limited to the distal antrum, the patient can be
offered radical distal or subtotal gastrectomy.
• At initial exploration, determine the resectability.
32. ANAESTHESIA
• General anesthesia with cuffed endotracheal intubation and
adequate muscle relaxation.
POSITION
• As a rule, the patient is laid supine on a flat table, the feet being
slightly lower than the head
34. INCISION
• A midline incision extending from the xiphoid skirting the umbilicus
• Additional exposure can be obtained by excising the xiphoid. Bone
wax is applied to the sternal end to control bleeding.
• Further exposure can be obtained by splitting the sternum with a
sternal knife.
• Chevron incision; the exposure provided by midline incision is usually
not as adequate as that provided by a chevron incision.
38. EXPLORATION
• Do not immediately palpate the stomach.
• Note any ascites and peritoneal deposits.
• Start your complete exploration from the pelvis and work towards
the stomach in order not to disperse malignant cells.
• Examine the greater omentum for deposits and then raise it to feel
the para-aortic nodes and those around the root of the mesentery,
and the right colic and middle colic arteries.
• Examine the full length of the small and then large intestine, seeking
peritoneal deposits on the bowel wall, the mesentery and the parietal
peritoneum.
• Look for incidental disease
39. • Now draw the omentum caudally to examine the upper
compartment.
• Feel both lobes of the liver and adjacent diaphragm, gallbladder and
free edge of the lesser omentum, the spleen, kidneys and adrenal
glands.
40. • Starting at the oesophageal hiatus and working distally, look and feel
for tumour involvement, fixity, glands and also incidental disease.
• Systematically move distally, avoiding handling or squeezing the
tumour if possible.
41. • Palpate the duodenum and feel the pancreas, then the region of the
coeliac axis just above the neck of the pancreas.
• If you are seriously in doubt whether to proceed, incise the lesser
omentum in an avascular area near the liver and examine the coeliac
axis and emerging arteries.
42. MOBILIZATION & RESECTION
• Lift the great omentum and dissect it from the transverse colon at the
bloodless plane of fusion between the folded omentum,
43. • Gently peel off the omentum, taking care not to damage the middle
colic artery
44. • At the left extremity of the greater omentum, Carefully dissect out the
lymph nodes at the origin of the left gastroepiploic artery, then doubly
ligate and divide the artery and vein.
45. • At the right extremity of the greater omentum Carefully isolate the
gastroepiploiec vessels and the subpyloric lymph nodes before doubly
ligating and dividing them at their origins
46. • Now draw the distal stomach caudally to put on stretch the free edge of
the lesser omentum.
• Carefully make a transverse incision in the anterior leaf above the
pylorus extend this towards the cardia, keeping close to the liver, it
reveals the right gastric vessels and the suprapyloric lymph nodes
• Dissect the nodes and doubly ligate and divide the right gastric blood
vessels.
47. • Perform Kocher's mobilization of the duodenum so that the first part
can be dissected from the head of the pancreas.
• Mobilize 5–6 cm of duodenum beyond the pylorus.
48. • Transect the duodenum-use GIA stapler or other mechanical stapler 2-
3cm of the first part.
49. • Elevation and cephalad traction on the stomach exposes the coeliac
axis, the left gastric artery, and the lymph nodes associated with
these vessels.
• The left gastric artery is doubly ligated divided near its origin with
division of the left gastric vein along the superior border of the
pancreas.
• The lymph nodes and fat along the branches coeliac axis, superior
border of the pancreas and infront of the portal veins are removed.
50. • Gastric division; subtotal gastrectomy (80-90%) by dividing the stomach
• 2 cm distal to OG junction along lesser curve and 5 cm distal along the greater
curvature. And at least 5cm resection margin otherwise a total gastrectomy is
done
• Straight occlusion clamp is placed along the greater curvature towards
remnant side and along lesser curve obliquely to create lesser curve.
• Crushing (Payr’s) or Kocher’s clamps are placed towards specimen side.
Stomach is cut using no. 15 blade.
• Specimen is placed in orientation grid. Intraoperative frozen section biopsy
is done to confi rm the clearance at margins.
52. POLYA METHOD
• Unit jejunum with open end of
the stomach.
• Anticolic or retrocolic
• Retrocolic; the jejunum is
brought through a rent in the
mesentry to the left of the
middle colic near the ligament
of treitz
• Grasp the jejunum with babcock
juxtaposition to the lesser
curvature of the stomach
• The jejunal loop is grasped in an
enterostomy clamp and
approximated to the posterior
surface of the posterior of the
stomach adjacent to the
noncrushing clamp by a layer of
closely placed interrupted 2-0
silk suture
53. This posterior layer
should include both
greater curvature and
lesser curvature of the
stomach , otherwise
subsequent closure of
the angle may be
insecure
Apply noncrusing
clamps several cm from
the line of staple on the
stomach – for stability
and prevent gross
soilage
54. Cut-off stapled line with
scissors and jejunum
open approximately
same size
Inner layer thru-and
thru approximating both
mucous membrane of
the stomach and
jejunum
55. • The corners are inverted with a Connell type suture tha is continued
anteriorly and the final knot is tied on the inside of the midline
• The anterior serosal layer are then approximated with interrupted 2-0
silk
• Finally at the upper and lower angles of the new stoma, additional
sutures are placed so that any strain exerted of the stoma is met by
these additional reinforcing serosal suture and not by the sutures of
the anastomosis.
71. POSTOPERATIVE CARE
• The patient is placed in a semi-Fowler’s position when conscious.
• Intravenous fluid, antibiotics, analgesics
• Correction of anaemia, electrolyte
• Chest physiotherapy
• Early ambulation, DVT prophylaxis
• NG tube
• Graded oral sips
• Feeding
72. COMPLICATIONS
• EARLY
• Intragastric hemorrhage
• Extragastric hemorrhage
• Duodenal blow out/ stump leakage
• Stomal obstruction
• Afferent loop obstruction
• Jejunal loop herniation
• Gastric remnant necrosis
• Postoperative pancreatitis
• Common bile duct injury or injury to ampula
• Omental infarction
74. FUTURE PROSPECTIVE
• SENTINEL LYMPH NODE BIOPSY
• Injection of isosulfan blue, indocyanine green
• Technetium 99m- radioisotope (standard)
• Intraoperative subserosal injection
• Injection is carried out in 4 quadrant of the tumour
75. • Estern studies node negative T1 and T2 and report accuracy of >98%
particularly in early stage
• Western countries included T3 and the accuracy was about 80%
• Complex lymphatics of the stomach and fear of skip metastesis –
make the selection of patient difficult
• Limited lyphadenectomy base on SLN is cautioned by several authors
and further studies are needed before this method can be introduce
into daily practice.
76. REFERENCES
1. Oliver M, Myles J. Classic operations on the upper gastrointestinal
tract. In; Farquharson's textbook of operative general surgery.
Edward Arnold publ. 9th ed. 272-279.
2. Robert M Z, Christopher E E. Gastrointestinal procedures. In;
Zollinger’s Atlas of surgical operation.Mc Graw Hill. 9th ed 64-79.
3. Winslet M C, Dawas K I. stomach and duodenum. In; Kirk’s General
Surgical operations. Churchill livingstone 6th ed 174-177.
4. SRB’s surgical operation text and atlas. Jaypee Brothers Medical
Publishers. 1st ed. 2014
77. REFERENCES
• 5. Robinson JO. History of gastric surgery. Postgrad Med J. 1960;
36;706-712
• 6. Songun I, et al. Lancet Oncol 2010; 11:439-49
• 7 . Tohru T, Hiromichi S, Masaji T. sentinel lymp node navigation for
gastric cancer: does it really benefit the patient? World J
gastroenterol. 2016 Mar 14; 22(10):2894-2899.
• 8. Arnold S G. The rationale of antrectomy and vagotomy for
duodenal ulcer. AMA Arch Surg. 1956;73(2):364-366