In any operation Indications. Anaesthesia. Position of the patient. Incision. Steps of the operation. Complications.
Abdominal operation I position for operation Supine
Abdominal operation I position for operation Trendelenbury
Abdominal operation I position for operation Lateral position
Anatomy of Abdominal wall Cross section of upper abdomen
Anatomy of Abdominal wall Cross section of lower abdomen
Anatomy of Abdominal wall Muscle & tendons of abdominal wall.
Anatomy of Abdominal wall Muscle & tendons of abdominal wall.
Anatomy of Abdominal wall Muscle & tendons of abdominal wall.
Anatomy of Abdominal wall Muscle & tendons of abdominal wall.
Anatomy of Abdominal wall Muscle & tendons of abdominal wall.
Anatomy of Abdominal wall Muscle & tendons of abdominal wall.
Abdominal incisions Incision Planning Adequate access. Minimum damage. Strong and durable scar. Langer s s line in children.
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. Ext. oblique ap. Int. oblique m. m Transversus. F. Tr.. + perit. Grid iron incision
Subcostal incision
Transverse upper Abdominal incision
Transverse upper Abdominal incision
Transverse lower Abdominal incision [Pfannenstiel]
Transverse lower Abdominal incision [Pfannenstiel]
Post operation complication Pulmonary. Cardiovascular. Shock Hemorrhage DVT GIT. Vomiting Abdominal distension Hiccough Urinary Uraemia Retention of urine Wound complication
Post operation wound complications Haematoma & Seroma. Infection. stitch sinus. Cellulitis. infected hematoma. Surgical emphysema. Wound dehiscence (complete burst) (partial burst).
Cholecystectomy
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.
Cholecystectomy Pre operative assessment of C.B.D. Ultrasound. IVC. ERCP / PTC.
Anaesthesia Cholecystectomy Position of patient (operative table/image image) Incision : - Subcostal - Rt paramedian
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
Cutaneus Extraction of CBD stone through T. tube track
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
Appendectomy Indications : Acute appendicitis (no mass) ). Recurrent or chronic App. Carcinoma of appendix. Carcinoid tumor of appendix.
Anaesthesia Appendectomy Position Incision - grid iron - Rt paramedian - lanz transverse incision
Post appendectomy complications Residual abscess (pelvic or subphrenic) ). Faecal fistula. Paralytic ileus. Wound infection. Wound hernia.
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
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)
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.
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.
Anaesthesia Nephrectomy Position Incision : -Lumbar - Bed of 12 th rib. - Anterior approach.
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.
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.
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.
Thyroidectomy Position Incision Steps
Thyoridectomy Complications Thyroid crises. Haemorrhage. Respiratory obstruction due to oedema. Rec. L. nerve injury. Hypothyroidism. Hypoparathyroidism. Recurrent toxicosis
Inguinal Hernia Repair