surgical operations

Separation of parts procedure. Transverse incision located at the inferior aspect of the rib cage facilitates the exposure of the semilunar ...

GA Prone Buttocks strapped apart Buttocks shaved fully Methylene Blue inserted to outline track IV antibiotics (cephazolin & metronidazo...

place rolled packs in subphrenic and subhepatic space avoid IVC compression effective packing is a wrap not a sandwich pack early (packing r...

Indication penetrating trauma with less than 10 mins CPR 5th ICS sternum to bed down on to rib cut down to pleura and through small area lat...

Three dark angels: acidosis, coagulopathy, hypothermia Indications SBP<90 Temp<34 APTT>60 pH<7.2 Pattern recognition Lactate >...

clinical exam intra compartmental pressures >30mmHg perfusion pressure <30-40mmHg (ie DBP-compartment pressure) Two incision technique...

Anatomy: 3 parts 1st: origin to scalenus anterior 2nd: medial SA to clavicle 3rd: clavicle to medial pec minor Area of SC artery to be expos...

•Choose the side you plan to biopsy eg R side •Left side down, lateral position •No need to break the bed •Lower border of the scapula is th...

Need to exclude testicular tumour first. Do U/S Aspiration and scrotal approach contra indicated until proven not tumour. Beware hernia can ...

•Preoperative marking of the site (usually on the pts left side and just below the level of the umbilicus) so that it does not sit in a crea...

Cremasteric artery is a branch of the inferior epigastric. This is a collateral supply to the testis. Preserve it in case of accidental liga...

Indications: 1.Impacted stone at ampulla of Vater 2.Papillary stenosis 3.Recurrent pancreatitis with multiple CBD stones Contraindications: ...

Lithotomy Pfannenstiel Alexis wound retractor Mobilise rectum as per Anterior resection to levator 2-0 prolene suture prolene mesh to sacrum...

Mobilise caecum Perform appendicectomy 3-0 PDS purse string 21G three way foley into caecum and tie snugly distal end into anaesthetic tubin...

Biliary bypass adds 2-5 months life Surgical bypass procedure of choice cf stenting in patient fit for surgery with > 4month life expecta...

GIST (b/w muscularis propria and muscularis mucosa, controversial to resect laparoscopically if over 5cm as higher malignancy rate, endoscop...

Oversewing pancreatic duct is associated with a lower pancreatic stump leakage rate

Beanbag Stirrups 20-30 Reverse Trendelenburg Compression stockings Stand between legs Nathanson Divide gastrohepatic ligament Separate right...

Contraindictions Acites: can leak and cause peritonitis Inability to transilluminate (can cutdowm to fascia to facilitate or can use bedside...

Indications GCS 3-8 and abnormal CT If normal CT, rate of elevated ICP is 10-15% so add: GCS <8, Normal CT, and two of: Age >40 SBP<...

Foley Pressure transducer zeroed at level of symphisis and inserted into aspiration port of IDC Clamp catheter Instil 50-100mL of saline Can...

midazolam/morphine LA infiltration with adrenaline 3cm vertical midline incision 2cm below umbilicus (above if preganant or pelvic fracture)...

Alternative to pyloroplasty in obstructing duodenal ulcer (more effective) and less morbid than antrectomy. Need to add vagotomy to prevent ...

Trauma laparotomy 1 Ethibond figure 8 interrupted suture Right side may be better to approach thorascopically

Controversies 1. Timing of surgery Total colectomy/end ileostomy (suture stump end to abdominal wound) if: -Diagnostic dilemma of Crohn'...

30-50% of all stomas will become permanent An ileostomy is better than a transverse colostomy (should be avoided at all costs) End Colostomy...

Upper limb •Arm – make a longitudinal incision laterally from deltoid insertion to lateral epicondyle. Identify the intermuscular septum and...

1.Position the patient supine with foot wrapped in drape/crepe. 2.Make an incision (Burgess) a hands-breadth or 10cm below the tibial tubero...

1.Position the patient supine with the leg wrapped in drape/crepe. 2.Make a fish-mouth incision at the level of intended amputation (supraco...

1.The arm is usually more resistant to critical ischaemia therefore hand remains viable and surgery can be performed at earliest convenience...

1.Position the patient supine. 2.Prepare the entire limb on the involved side only. 3.Make a vertical incision over the mid-inguinal point a...

1.Obtain a pre-operative US of incompetent perforators and have them marked on the skin. Mark individual varicosities with a permanent marke...

Patient supine. Prep from lower chest to mid thighs Check status of lower limb pulses preoperatively Large midline incision 2.Place a self-r...

Sphincterotomy 1.Position the patient in lithotomy. 2.Perform a EUA including a digital and rigid sigmoidoscopy. Determine the status of the...

Operation to choose: Old, small prolapse: Delormes Old, bigger prolapse: Altemeier Young, no constipation: Abdominal rectopexy Young, consti...

Described by Miles in 1925 Anatomy: Denonvilliers fascia:The consensus is that this fascia represents the fusion of the walls of the periton...

ANATOMY Ileocolic is a constant vessel Right colic is a direct branch of SMA in only 13% cases. Middle colic forms a vascular arcade with il...

1.Prep and square drape, ensure NGT 2.Upper midline incision 3.Place a fixed retractor such as omnitract to aid in retraction of the liver. ...

In general perform a laparoscopy first if cancer operation. No need if if clear indication for palliative resection ie bleeding etc. Resecti...

Perforated peptic ulcer 1.Position the patient supine. 2.Make an upper midline incision 3.Conduct a laparotomy to determine the cause for th...

Indications include oesophageal pH <4, recorded 5cm above a manometrically defined LOS, present for >4%/24hrs, Complicated - oesophagi...

1.Short upper midline incision 2.Choose area of mid-stomach, closer to greater curve and place a pursestring suture of 2cm diameter using 3/...

1.Double lumen tube. Conduct a laparotomy and assess resectability. Determine adequacy of right gastric and right gastroepiploic vessels. 2....

1.Position the patient in lithotomy, reverse Trendelenberg. 2.There should be two monitors on either side of the head end of the table. 3.Ca...

Repair of pharyngo-oesophageal diverticulum 1.Position the patient supine on a head ring facing the right side with a sandbag between the sh...

Preop Vaccinations: meningococcal, haemophilus, pneumovax steroids in ITP Antibiotics 1.Position patient supine with the left side raised in...

Duodenum •Primary repair +/- gastro-enterostomy •Roux limb •Jejunal serosal patch •Damage control oversew with catheter duodenostomy, divers...

1.Position the patient supine. 2.Upper midline incision (or rooftop). 3.Conduct a laparotomy. If the GB is still present, perform a cholecys...

1.Position the patient supine. 2.Make a subcostal or midline incision. 3.Conduct a laparotomy. 4.Dissect the greater omentum off the transve...

Salient facts about liver abscesses and hydatid cysts •Amoebic abscesses do not require aspiration or drainage/treat with AB’s only. •Pyogen...

Salient facts about Choledochoduodenostomy •Requires a CBD of at least 15mm diameter. •Must Kocherize the duodenum to have a tension free an...