GI Surgeries Flashcards
What are the most common complications which can occur from major abdominal surgery?
adhesions bleeding infection paralytic ileus perioperative mortality shock scarring
When is an oesophagectomy indicated?
advanced Barrett’s
non-metastatic cancer
What types of oesophagectomy are there and what is the premise of the operation?
trans-Hiatal or transthoracic
a segment of stomach is pulled up into the chest + connected with the remaining oesophagus
What are the potential complications of oesophagectomy?
intra-op:
haemorrhage
injury to surrounding structures
anaesthetic risks
early: pain infection chyle leak anastomotic leak blood clots stroke, MI, AKI, death
late:
recurrence
weight loss
reduced nutrition
What are the indications for gastrectomy? What types of procedure are there?
indicated in:
cancer, long-term hiatus hernia, Barrett’s
antrectomy = 30% resection
hemigastrectomy = 50% resection
subtotal gastrectomy = 80% resection
What complications can occur as a result of a gastrectomy?
intra:
injury to adjacent structures
bleeding
anaesthetic risks
early:
post-op bleeding
luminal bleeding
pain etc
late:
increased osmotic load to duodenum –> fluid shift from intravascular compartment –> hyperperistaltic response from duodenum –> lightheadedness, palpitations, crampy abdo pain
recurrent ulcer
What are the indications for laparoscopic cholecystectomy?
gallstone disease
What complications can occur as a result of laparoscopic cholecystectomy?
intra: usual stuff
bile duct injury
conversion to open surgery
subtotal + drain insertion
early: usual
bile leak
seroma
scarring
late: usual adhesions hernia bile duct stricture diarrhoea or reflux gastritis
When is a R Hemi-colectomy performed and how?
normally cancer treatment - maybe IBD
remove ascending colon + caecum
laparotomy or laparoscopic mid-line approach
all major organs inc uterus and ovaries inspected and palpated
What complications can occur as a result of a R Hemi-colectomy?
intra: usual
injury to liver + ureter
stoma formation
early: usual
late: usual, hernia, adhesions
What complications can occur as a result of an anterior resection?
intra: usual
injury to liver + ureter
stoma formation
early: usual
late: usual, hernia, adhesions
When is an anterior resection performed and what is involved?
rectal cancer
remove the diseased portion of bowel with diverticulitis
upper 2/3rds of rectum resected
end colostomy formed
When is a Hartmann’s procedure performed?
complicated diverticulitis rectosigmoid cancer volvulus perforation lymphoma IBD etc
Describe the Hartmann’s procedure
midline incision down through fascia abdomen examined to confirm diagnosis and normalisation sigmoid colon exposed and mobilised lateral peritoneal reflection incised dissection carried out at proximal and distal ends proximal transected bowel selected descending colon divided colostomy created midline incision closed
What complications can occur as a result from Hartmann’s procedure?
wound infection rectal stump leak abscesses fistula retraction parastomal hernia skin irritation paralytic ileus wound dehiscence ureteral injury general surgical consequences
When would you perform and abdominoperineal excision of the rectum? How would you do it?
rectal carcinoma
recurrent or residual anal carcinoma
incisions made in abdomen and perineum
anus –> sigmoid removed with associated lymph nodes
remaining sigmoid brought out as colostomy
What complications can occur with an abdominoperineal excision of rectum?
haemorrhage infection CR damage to ureter hernia DVT/PE colostomy blockage
Why would you decide to make a stoma in surgery?
anastomosis doesn’t look secure/inflammation is too great
temporarily, to allow bowel that was operated on to heal
removing the rectum/cannot
How can surgery be used to treat haemorrhoids?
internal:
grade III or IV - surgical haemorrhoidectomy, stapling, operative resection
external:
office excision or operative resection
How can you surgically treat fissures?
for anal fissures which are still symptomatic after 3-4 weeks of medical therapy
sphincter dilation - controlled stretch under anaesthetic, helps allow fissure to heal by correcting abnormality
lateral internal sphinctecretomy - cut hypertrophied internal sphincter –> relieves tension and allows fissure to heal
How can you surgically treat an anal fistula?
fistulotomy
pass probe through internal and external openings
cut overlying tissue –> open entire fibrous tract
seton +/- fistulotomy
How can surgery be used to treat a rectovaginal fistula?
draining seton
endorectal advancement flap +/- sphincteroplasty
