Practical Surgery Mushkies Flashcards
Nissen Fundoplication aim?
Prevent reflux and repair diaphragm
Nissen Fundoplications procedure?
- Usually lap
- Wrap gastric fundus around lower oesophagus
- Close any diaphragmatic hiatus
Complications of Nissen Fundoplication?
- Gas-bloat syndrome = inability to belch/vomit
2. Dysphagia if wrapped too tight
Types of gastrectomy?
- Antrectomy
- Total Gastrectomy
- Subtotal Gastrectomy
Antrectomy types?
- Bilroth I = simple anastomosis
2. Bilroth II = duodenal stump oversown + gastrojejunostomy
Complications of gastrectomy?
- Physical
2. Metabolic
Physical complications of gastrectomy?
- Increased risk of gastric cancer
- Reflux or bilious vomiting
- Abdominal fullness
- Stricture
- Stump leakage
Metabolic complications of gastrectomy?
- Dumping syndrome
- Blind loop syndrome
- Vitamin deficiency = B12, osetoporosis, bypassing proximal SB –> Fe and folate deficiency
- Weight loss = malabsorption
Blind loop syndrome?
Overgrowth of bacteria in duodenal stump, leading to malabsorption and diarrhoea
Dumping syndrome?
Collection of signs and symptoms that occurs post gastrectomy when sugar moves too quickly into the duodenum, characterised by 2 phases:
- Early DS (10-30mins after meal) = osmotic hypovolaemia
- Late DS (2-3 hours after meal) = reactive hypoglycaemia
S&S of dumping syndrome?
Abdo distension, flushing, N&V, fainting, sweating
Ivor-Lewis Oesophagectomy?
2-stage surgical procedure for removing tumours of the distal 2/3rds of the oesophagus
1st = abdominal rooftop incision
2nd = right thoracotomy
Whipple’s procedure?
Pancreaticoduodenectomy performed for removing tumours of the head of the pancreas, including removal of:
- Gastric antrum
- Gallbladder
- Head of pancreas
- Proximal duodenum
- Regional lymph nodes
EVAR complications?
- MI
- Spinal or mesenteric ischaemia
- Renal failure
- Graft migration or stenosis
- Endoleaks
What are endoleaks?
Persistent blood flow within the aneurysm sac following EVAR
EVAR advantages?
- Reduced perioperative mortality
- Less stress in high risk pts
- Reduced hospital stay
- Improved cosmesis
EVAR disadvantages?
- No data on long term outcomes
- Cant be used on all aneurysms
- Lifelong monitoring with CT for endoleaks
- More expensive
- Doubtful long term advantage in terms of all cause mortality
Carotid endarterectomy complications?
- 7% risk of stroke/death w/in 30d
- Haemorrhage –> haematoma
- MI
- Hypoglossal nerve damage = rare
Indications for bypass grafting?
- Very short claudication distance
- Symptoms affecting pts QoL
- Development of rest pain
Practicalities of bypass grafting?
- Need good proximal supply and sital run off
- More distal grafts have increased rates of thrombosis
- Saphenous vein grafts have increased rates of thrombosis
- Prosthetic grafts may be employed
Bypass grafting procedures?
- Aorta/double iliac occlusion = aorto-bifem/axillo-fem
- Single iliac = aorto-fem/fem-fem crossover/axillo-fem
- SFA/PF = Fem-pop/fem-distal
Complications of bypass grafting?
- Haematoma
- Distal embolism
- Thrombosis
TURP indications?
Surgical rx of choice for BPH when medical Rx has failed
Principals of TURP?
- Performed under spinal anesthetic
- Cytoscopic inspection
- Locate external urethral sphincter and use as distal resection landmark
- Electrosurgical resection of prostatic tissue under direct vision
- Send chippings for histology
- Insert 3 way catheter post-op to irrigate bladder
Complications of TURP?
- Immediate
- Early
- Late
Immediate complications of TURP?
- TURP syndrome = absorption of large quantity of fluids -> reduced Na
- Haemorrhage
Early complications of TURP?
- Haemorrhage
- Infection
- Clot retention = requires bladder irrigation
Late complications of TURP?
- Retrograde ejaculation = common
- ED = 10%
- Incontinence = <10%
- Urethral stricture = LUTS post TURP
- Recurrence
Dohlman’s procedure?
Pharyngeal pouch = minimally invasive endoscopic stapling
Heller’s cardiomyotomy?
Achalasia = longitudinal incision through muscularis propria at LOS
Ramstedt’s pyloromyotomy?
Pyloric stenosis = longitudinal incision through muscularis propria at the pylorus
Ivor-Lewis?
Oesophageal cancer = 2-stage oesophagectomy
Anal fissure surgery?
Lateral sphincterotomy = division of internal anal sphincter @ 3 o clock
Delorme’s procedure?
Rectal prolapse = perineal approach with mucosal resection
Trendelenberg operation?
Varicosities = SFJ ligation
Cockett’s operation?
Varicosities = perforator ligation
Trahere transplantation?
Chronic venous insufficiency = transplant of axillary vein with valve into the deep venous leg veins
Kistner operation?
Chronic venous insufficiency = venous valvuloplasty
Palma operation?
Chronic venous insufficiency = bypass venous obstruction with contralateral GSV
Palomo operation?
- Varicocoele = high retroperitoneal approach for ligation of testicular veins
- Transverse incision at level of the ASIS centred on the mid-inguinal point
Lord’s repair?
Hydrocele = plication of the tunica vaginalis
Jaboulay’s repair?
Hydrocele = eversion of the tunica vaginalis
Dartos Pouch Procedure?
Undescended testis = mobilisation of testis and placement in a s/c pouch via a hole in the dartos muscle (dartos prevents retraction)
Sistrunk’s operation?
Thyroglossal cyst = excision of cyst and thyroglossal duct
