In any operation. Indications. Anaesthesia. Position of the patient. Incision. Steps of the operation. Complications.

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1 In any operation Indications. Anaesthesia. Position of the patient. Incision. Steps of the operation. Complications.

2 Abdominal operation I position for operation Supine

3 Abdominal operation I position for operation Trendelenbury

4 Abdominal operation I position for operation Lateral position

5 Anatomy of Abdominal wall Cross section of upper abdomen

6 Anatomy of Abdominal wall Cross section of lower abdomen

7 Anatomy of Abdominal wall Muscle & tendons of abdominal wall.

8 Anatomy of Abdominal wall Muscle & tendons of abdominal wall.

9 Anatomy of Abdominal wall Muscle & tendons of abdominal wall.

10 Anatomy of Abdominal wall Muscle & tendons of abdominal wall.

11 Anatomy of Abdominal wall Muscle & tendons of abdominal wall.

12 Anatomy of Abdominal wall Muscle & tendons of abdominal wall.

13 Abdominal incisions Incision Planning Adequate access. Minimum damage. Strong and durable scar. Langer s s line in children.

14 Types of incisions

15 Midline incision

16 Midline incision

17 Repair of complete burst abdomen Midline incision

18 Paramedian incision

19 Paramedian incision

20 Paramedian incision

21 Paramedian incision

22 Paramedian incision (closure)

23 Skin. Ext. oblique ap. Int. oblique m. m Transversus. F. Tr.. + perit. Grid iron incision

24 Subcostal incision

25 Transverse upper Abdominal incision

26 Transverse upper Abdominal incision

27 Transverse lower Abdominal incision [Pfannenstiel]

28 Transverse lower Abdominal incision [Pfannenstiel]

29 Post operation complication Pulmonary. Cardiovascular. Shock Hemorrhage DVT GIT. Vomiting Abdominal distension Hiccough Urinary Uraemia Retention of urine Wound complication

30 Post operation wound complications Haematoma & Seroma. Infection. stitch sinus. Cellulitis. infected hematoma. Surgical emphysema. Wound dehiscence (complete burst) (partial burst).

31 Cholecystectomy

32 Indications : Cholecystectomy Chronic calcular cholecystitis. Acute calcular cholecystitis (within 48 H.) H Trumatic rupture. Malignant gall bladder + wedge of liver. In hepatic resection. Symptomless gall stones in some cases - Diabetes -Big stones - non functioning gall bladder - calcified (porcalen) G.B.

33 Cholecystectomy Pre operative assessment of C.B.D. Ultrasound. IVC. ERCP / PTC.

34 Anaesthesia Cholecystectomy Position of patient (operative table/image image) Incision : - Subcostal - Rt paramedian

35 Plain X ray Radio opaqu Gall stones

36 Ultrasound Show gall stone with posterior shadow

37 Oral cholecystogram

38 Plain X ray Calcified gall bladder

39 ERCP Normal bile ducts

40 ERCP Multiple CBD stones

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44 Sites of Towels

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62 Missed CBD stone T-tube still present

63 Cutaneus Extraction of CBD stone through T. tube track

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76 Cholecystectomy Complications Haemorrhage Liver failure due to hepatic A. A ligation. Injury of bile ducts. * Jaundice * Biliary peritonitis * Biliary fistula Post cholecystectomy syndrome * stone missed * stricture CBD * Stump long * Symptoms due to other pathology

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81 Appendectomy Indications : Acute appendicitis (no mass) ). Recurrent or chronic App. Carcinoma of appendix. Carcinoid tumor of appendix.

82 Anaesthesia Appendectomy Position Incision - grid iron - Rt paramedian - lanz transverse incision

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93 Post appendectomy complications Residual abscess (pelvic or subphrenic) ). Faecal fistula. Paralytic ileus. Wound infection. Wound hernia.

94 Splenectomy Indications :- Rupture spleen. Conditions related to the spleen. -Cysts -Tumor -T.B -Abscess Splenic artery aneurysm. With total gastrectomy for cancer stomach. Splenomegaly with blood diseases. -cong. Spherocytosis - Haemolytic anemia (auto immune) -Hyper splenism - malarial spleen (Tropical) In relation to portal hypertension - Hassab - Proximal spleno-renal shunt

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106 End side porta caval anastmosis

107 End side cavo mesenteric anastmosis

108 H graft Mesent. caval anastmosis

109 Central spleno-renal anastmosis

110 Distal spleno-renal anastmosis (Warren shunt)

111 Post splenectomy complications 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.

112 Nephrectomy Indications :- Patient having transplant & his own kidney is infected or causing renal hypertension. Non functioning kidney (the other is normal) in association with :- Hydronephrosis - Byonephrosis stones - ischemia Trauma (inevitable) T.B. (resistant treatment) Tumors : renal cell T. Radical Tr. Cell T. Nephro-uretrectomy Unilateral renal hypertension if failed renal A. reconstruction.

113 Anaesthesia Nephrectomy Position Incision : -Lumbar - Bed of 12 th rib. - Anterior approach.

114 Nephrectomy In renal carcinoma : More radical kidney + perinephric fat + supra renal G. G Ligation of renal vein early. In Rt. Side (the vein is short) open IV.C. to remove tumor emboli.

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129 Indications :- Thyoridectomy 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.

130 Types of Thyoridectomy 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.

131 Thyroidectomy Position Incision Steps

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149 Thyoridectomy Complications Thyroid crises. Haemorrhage. Respiratory obstruction due to oedema. Rec. L. nerve injury. Hypothyroidism. Hypoparathyroidism. Recurrent toxicosis

150 Inguinal Hernia Repair

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