In any operation
•• Indications Indications ..•• AnaesthesiaAnaesthesia ..•• Position of the patient Position of the patient ..•• Incision Incision ..•• Steps of the operation Steps of the operation ..•• Complications Complications ..
Abdominal operation
SupineSupine
I position for operation
Abdominal operation
TrendelenburyTrendelenbury
I position for operation
Abdominal operation
Lateral positionLateral position
I position for operation
Cross section of upper abdomenCross section of upper abdomen
Anatomy of Abdominal wall
Cross section of lower abdomenCross section of lower abdomen
Anatomy of Abdominal wall
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
Incision Planning
Adequate access Adequate access ..
Minimum damage Minimum damage ..
Strong and durable scar Strong and durable scar ..
LangerLanger’’s line in children s line in children ..
Abdominal incisions
Types of incisions
Midline incision
Midline incision
Repair of complete
burst abdomen
Midline incision
Paramedian incision
Paramedian incision
Paramedian incision
Paramedian incision
Paramedian incision (closure)
Skin Skin ..ExtExt. . oblique oblique apap..IntInt. . oblique moblique m..TransversusTransversus ..FF. . TrTr. + . + peritperit ..
Grid iron incision
Subcostal incision
Transverse upper Abdominal incision
Transverse upper Abdominal incision
Transverse lower Abdominal incision[Pfannenstiel]
Transverse lower Abdominal incision[Pfannenstiel]
Pulmonary Pulmonary ..Cardiovascular Cardiovascular ..
ShockShockHemorrhageHemorrhageDVTDVT
GITGIT..Vomiting Vomiting Abdominal distensionAbdominal distensionHiccoughHiccough
UrinaryUrinaryUraemiaUraemiaRetention of urineRetention of urine
Wound complicationWound complication
Post operation complication
HaematomaHaematoma & & SeromaSeroma ..
Infection Infection ..stitch sinus .Cellulitis .infected hematoma.
Surgical emphysema Surgical emphysema ..
Wound dehiscenceWound dehiscence (complete burst)(partial burst) .
Post operation wound complications
Cholecystectomy
Indications :
Chronic Chronic calcularcalcular cholecystitischolecystitis ..Acute Acute calcularcalcular cholecystitischolecystitis ((within 48 Hwithin 48 H.).)TrumaticTrumatic rupture rupture ..Malignant gall bladder Malignant gall bladder + + wedge of liver wedge of liver ..In hepatic resection In hepatic resection ..SymptomlessSymptomless gall stones in some casesgall stones in some cases
-- Diabetes - Big stones- non functioning gall bladder - calcified (porcalen) G.B.
Cholecystectomy
Ultrasound Ultrasound ..
IVC IVC ..
ERCP ERCP / / PTC PTC ..
Pre operative assessment of C.B.D.
Cholecystectomy
AnaesthesiaAnaesthesia
Position of patientPosition of patient((operative tableoperative table//imageimage))
Incision Incision ::-- SubcostalSubcostal-- RtRt paramedianparamedian
Cholecystectomy
Plain X ray
Radio opaqu
Gall stones
Ultrasound
Show gall stone with posterior shadow
Oral cholecystogram
Plain X ray
Calcified gall bladder
ERCP
Normal bile ducts
ERCP
Multiple
CBD stones
Sites of Towels
Missed CBD stone
T-tube still present
CutaneusExtraction of CBD stone through T. tube track
ComplicationsHaemorrhageHaemorrhageLiver failure due to hepatic ALiver failure due to hepatic A. . ligationligation ..Injury of bile ducts Injury of bile ducts ..
* Jaundice * Biliary peritonitis * Biliary fistula
Post Post cholecystectomycholecystectomy syndromesyndrome* stone missed* stricture CBD* Stump long* Symptoms due to other pathology
Cholecystectomy
Indications :
Acute appendicitis Acute appendicitis ((no massno mass) .) .
Recurrent or chronic AppRecurrent or chronic App. .
Carcinoma of appendix Carcinoma of appendix ..
CarcinoidCarcinoid tumor of appendix tumor of appendix ..
Appendectomy
AnaesthesiaAnaesthesia
Position Position
IncisionIncision-- grid irongrid iron-- RtRt paramedianparamedian-- lanzlanz transverse incisiontransverse incision
Appendectomy
Residual abscess Residual abscess ((pelvic or pelvic or subphrenicsubphrenic) .) .
FaecalFaecal fistula fistula ..
Paralytic Paralytic ileusileus ..
Wound infection Wound infection ..
Wound hernia Wound hernia ..
Post appendectomy complications
SplenectomyIndications :-
Rupture spleen Rupture spleen ..Conditions related to the spleen Conditions related to the spleen . .
- Cysts - Tumor- T.B - Abscess
SplenicSplenic artery aneurysm artery aneurysm ..With total With total gastrectomygastrectomy for cancer stomach for cancer stomach ..SplenomegalySplenomegaly with blood diseases with blood diseases ..
- cong. Spherocytosis- Haemolytic anemia (auto immune)- Hyper splenism- malarial spleen (Tropical)
In relation to portal hypertensionIn relation to portal hypertension- Hassab - Proximal spleno-renal shunt
End – side porta – caval anastmosis
End – side cavo – mesenteric anastmosis
H – graft Mesent. – caval anastmosis
Central spleno-renal anastmosis
Distal spleno-renal anastmosis(Warren shunt)
Haemorrage .Pancreatic injury .Gastric injury gastric fistula .Colonic injury colonic fistula .Left subphrenic collection & abscess .D. V. T.Burst abdomen due to wound sepsis .Infection specially in children .
Post splenectomy complications
NephrectomyIndications :-
Patient having transplant & his own kidney is infected or causing renal hypertension.Non functioning kidney (the other is normal) in association with :-
Hydronephrosis - Byonephrosisstones - ischemia
Trauma (inevitable)T.B. (resistant treatment)Tumors :
renal cell T. RadicalTr. Cell T. Nephro-uretrectomy
Unilateral renal hypertension if failed renal A. reconstruction .
NephrectomyAnaesthesiaAnaesthesia
Position Position
Incision Incision ::- Lumbar- Bed of 12th rib.- Anterior approach.
NephrectomyIn renal carcinoma :
More radical More radical kidney kidney + + perinephricperinephric fat fat + + supra renal Gsupra renal G..
LigationLigation of renal vein early of renal vein early ..
In In RtRt. . Side Side ((the vein is shortthe vein is short) ) open open IVIV..CC. . to remove tumor emboli to remove tumor emboli ..
ThyoridectomyIndications :-
Simple diffuse goitre + pressure .S. N. G. to avoid complications .Solitary Nodule .1 ry toxic goitre after medications .2 ry toxic goitre after medications .Malignant goitre .
Subtotal :-Bilateral removal leaving small parts .
Hemi thyroidectomy :-(Lobectomy) = entire lobe + isthmus .
Total thyoidectomy :-Rilat. Lobectomy + implantation of
parathyroid .Excision of isthmus
to relief pressure on trachea .
Types of Thyoridectomy
ThyroidectomyPosition Position
IncisionIncision
StepsSteps
Thyoridectomy
Complications
Thyroid crises .Haemorrhage .Respiratory obstruction due to oedema.Rec. L. nerve injury .Hypothyroidism .Hypoparathyroidism .Recurrent toxicosis
Inguinal Hernia Repair
