Surgical Operations You Should Know, Chapter 14 P82-91

Question 1

Define the following procedures:
1. Billroth I
P82 (picture)

Answer 1

Antrectomy with gastroduodenostomy

Question 2

2. Billroth II

P82 (picture)

Answer 2

Antrectomy with gastrojejunostomy

Question 3

3. How can the difference between a Billroth I and a
   Billroth II be remembered?
   P82 (picture)

Answer 3

Billroth 1 has one limb; Billroth 2 has two limbs

Question 4

Describe the following procedures:
1. Roux-en-Y limb
P83 (picture)

Answer 4

Jejunojejunostomy forming a Y-shaped figure of small bowel; the free end can then be anastomosed to a second hollow structure (e.g., esophagojejunostomy)

Question 5

2. Brooke ileostomy

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Answer 5

Standard ileostomy that is folded on itself to protrude from the abdomen ≈2 cm to allow easy appliance placement and collection of succus

Question 6

3. CEA

P83

Answer 6

Carotid EndArterectomy; removal of atherosclerotic plaque from a carotid artery

Question 7

4. Bassini herniorrhaphy

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Answer 7

Repair of inguinal hernia by approximating transversus abdominis aponeurosis and the conjoint tendon to the reflection of Poupart’s (inguinal) ligament

Question 8

5. McVay herniorrhaphy

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Answer 8

Repair of inguinal hernia by approximating the transversus abdominis aponeurosis and the conjoint tendon to
Cooper’s ligament (which is basically the superior pubic bone periosteum)

Question 9

6. Lichtenstein herniorrhaphy

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Answer 9

“Tension-free” inguinal hernia repair using mesh (synthetic graft material)

Question 10

7. Shouldice herniorrhaphy

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Answer 10

Repair of inguinal hernia by imbrication of the transversalis fascia, transversus abdominis aponeurosis, and the conjoint tendon and approximation of the transversus abdominis aponeurosis and the conjoint tendon to the inguinal ligament

Question 11

8. Plug and patch hernia repair

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Answer 11

Prosthetic plug pushes hernia sac in and then is covered with a prosthetic patch to repair inguinal hernias

Question 12

9. APR

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Answer 12

AbdominoPerineal Resection; removal of the rectum and sigmoid colon through abdominal and perineal incisions (patient is left with a colostomy); used for low rectal cancers 8 cm from the anal verge

Question 13

10. LAR

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Answer 13

Low Anterior Resection; resection of low rectal tumors through an anterior abdominal incision

Question 14

11. Hartmann’s procedure

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Answer 14

1. Proximal colostomy

2. Distal stapled-off colon or rectum that is left in peritoneal cavity

Question 15

12. Mucous fistula

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Answer 15

Distal end of the colon is brought to the abdominal skin as a stoma (proximal end is brought up to skin as an end colostomy)

Question 16

13. Kocher (“koh-ker”) maneuver

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Answer 16

Dissection of the duodenum from the right-sided peritoneal attachment to allow mobilization and visualization of the back of the duodenum/pancreas

Question 17

14. Seldinger technique

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Answer 17

Placement of a central line by first placing a wire in the vein, followed by placing the catheter over the wire

Question 18

15. Cricothyroidotomy

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Answer 18

Emergent surgical airway through the cricoid membrane

Question 19

16. Hepaticojejunostomy

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Answer 19

Anastomosis between a jejunal roux limb and the hepatic ducts

Question 20

17. Puestow procedure

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Answer 20

Side-to-side anastomosis of the pancreas and jejunum (pancreatic duct is filleted open)

Question 21

18. Stamm gastrostomy

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Answer 21

Gastrostomy placed by open surgical incision and tacked to the abdominal wall

Question 22

19. Highly selective vagotomy

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Answer 22

Transection of vagal fibers to the body of the stomach without interruption of fibers to the pylorus (does not need
pyloroplasty or other drainage procedure because the pylorus should still function)

Question 23

20. Enterolysis

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Answer 23

Lysis of peritoneal adhesions

Question 24

21. LOA

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Answer 24

Lysis Of Adhesions (enterolysis)

Question 25

22. Appendectomy | P86

Answer 25

Removal of the appendix

Question 26

23. Lap appy | P86

Answer 26

Laparoscopic removal of the appendix

Question 27

24. Cholecystectomy | P86

Answer 27

Removal of the gallbladder

Question 28

25. Lap chole | P86

Answer 28

Laparoscopic removal of the gallbladder

Question 29

26. Nissen | P86 (picture)

Answer 29

Nissen fundoplication; 360 wrap of the stomach by the fundus of the stomach around the distal esophagus to prevent reflux

Question 30

27. Lap Nissen | P87

Answer 30

Nissen fundoplication with laparoscopy

Question 31

28. Simple mastectomy | P87

Answer 31

Removal of breast and nipple without removal of nodes

Question 32

29. Choledochojejunostomy | P87

Answer 32

Anastomosis of the common bile duct to the jejunum (end to side)

Question 33

30. Graham patch | P87

Answer 33

Placement of omentum with stitches over a gastric or duodenal perforation (i.e., omentum is used to plug the hole)

Question 34

31. Heineke-Mikulicz pyloroplasty | P87 (picture)

Answer 34

Longitudinal incision through all layers of the pylorus, sewing closed in a transverse direction to make the pylorus nonfunctional (used after truncal vagotomy)

Question 35

32. Pringle maneuver | P87 (picture)

Answer 35

Temporary occlusion of the porta hepatis (for temporary control of liver blood flow when liver parenchyma is actively bleeding)

Question 36

33. Modified radical mastectomy | P88

Answer 36

Removal of the breast, nipple, and axillary lymph nodes (no muscle is removed)

Question 37

34. Lumpectomy and radiation | P88

Answer 37

Removal of breast mass and axillary lymph nodes; normal surrounding breast tissue is spared; patient then undergoes postoperative radiation treatments

Question 38

35. I & D | P88

Answer 38

Incision and Drainage of pus; the wound is then packed open

Question 39

36. Exploratory laparotomy | P88

Answer 39

Laparotomy to explore the peritoneal cavity looking for the cause of pain, peritoneal signs, obstruction, hemorrhage, etc.

Question 40

37. TURP | P88

Answer 40

TransUrethral Resection of the Prostate; removal of obstructing prostatic tissue via scope in the urethral lumen

Question 41

38. Fem pop bypass | P88 (picture)

Answer 41

FEMoral artery to POPliteal artery bypass using synthetic graft or saphenous vein; used to bypass blockage in the femoral artery

Question 42

39. Ax Fem | P89 (picture)

Answer 42

Long prosthetic graft tunneled under the skin placed from the AXillary artery to the FEMoral artery

Question 43

40. Triple A repair | P89

Answer 43

Repair of an AAA (Abdominal Aortic Aneurysm): | Open aneurysm and place prosthetic graft; then close old aneurysm sac around graft

Question 44

41. CABG | P89 (picture)

Answer 44

Coronary Artery Bypass Grafting; via saphenous vein graft or internal mammary artery bypass grafts to coronary arteries from aorta (cardiac revascularization)

Question 45

42. Hartmann’s pouch | P89

Answer 45

Oversewing of a rectal stump (or distal colonic stump) after resection of a colonic segment; patient is left with a proximal colostomy

Question 46

43. PEG | P90 (picture)

Answer 46

Percutaneous Endoscopic Gastrostomy: Endoscope is placed in the stomach, which is then inflated with air; a needle is passed into the stomach percutaneously, wire is passed through the needle traversing the abdominal wall, and the gastrostomy is then placed by using the Seldinger technique over the wire

Question 47

44. Ileoanal pull-through | P90

Answer 47

Anastomosis of the ileum to the anus after total proctocolectomy

Question 48

45. Hemicolectomy | P90

Answer 48

Removal of a colonic segment (i.e., partial colectomy)

Question 49

46. Truncal vagotomy | P90 (picture)

Answer 49

Transection of the vagus nerve trunks; must provide drainage procedure to stomach (e.g., gastrojejunostomy or pyloroplasty) because after truncal vagotomy, the pylorus does not relax

Question 50

47. Antrectom | P91

Answer 50

Removal of stomach antrum

Question 51

48. Whipple procedure | P91 (picture)

Answer 51

Pancreaticoduodenectomy: - Cholecystectomy - Truncal vagotomy - Pancreaticoduodenectomy—removal of the head of the pancreas and duodenum - Choledochojejunostomy - Pancreaticojejunostomy (anastomosis of distal pancreas remnant to the jejunum) - Gastrojejunostomy (anastomosis of stomach to jejunum)

Question 52

49. Excisional biopsy | P91

Answer 52

Biopsy with complete excision of all suspect tissue (mass)

Question 53

50. Incisional biopsy | P91

Answer 53

Biopsy with incomplete removal of suspect tissue (incises tissue from mass)

Question 54

51. Tracheostomy | P91

Answer 54

Placement of airway tube into trachea surgically or percutaneously