Surgical procedures

Question 1

Whipple’s resection

Answer 1

Pancreaticoduodenectomy (indicated for pancreatic cancer), SE: dumping syndrome, PUD

Question 2

Sengstaken-Blakemore tube

Answer 2

Oesophageal varices mx

Question 3

Ivor-lewis type oesophagectomy

Answer 3

Indicated for oesophageal cancer

Involves laparotomy + right thoracotomy

Question 4

Trendenleberg’s ligation

Answer 4

For varicose veins at saphenofemoral junction

Question 5

Cockett’s ligation

Answer 5

Perforator vein

Question 6

Short saphenous vein ligation

Answer 6

For short saphenous vein in popliteal fossa

Question 7

Trahere transplantation

Answer 7

Vascular - transport axillary vein into deep venous system

Question 8

Kistner transplantation

Answer 8

Venous valvuloplasty

Question 9

Palma transplantation

Answer 9

Bypass venous op - with contralateral great saphenous vein

Question 10

What are the two types of oesophagectomy procedure and what do each involve?

Answer 10

1. Ivor Lewis - laparotomy + right thoracotomy

2. McKeown - laparotomy + right thoracotomy + left neck incision

Question 11

What is a Nissen fundoplication used for?

Answer 11

GORD

Question 12

What are some causes of small bowel obstruction? What drug may be given to these pts and why?

Answer 12

Adhesions
Hernia
Malignancy including non-GI eg ovarian mass or enlarged LN

Gastrograffin to reduce bowel wall oedema

Question 13

What are some causes of large bowel obstruction?

Answer 13

Sigmoid volvulus
Malignancy
Strictures eg secondary to diverticular disease

Question 14

Management of sigmoid volvulus?

Answer 14

Therapeutic sigmoidoscopy with flatus tube

Question 15

Management of caecal volvulus?

Answer 15

Laparotomy +/- right hemicolectomy

Question 16

Procedure indicated for higher rectal tumours? What is removed?

Answer 16

Anterior resection - removes sigmoid colon and top part of rectum

Question 17

What procedure is indicated for lower rectal tumours? What is removed?

Answer 17

Abdominoperineal resection - anus to top of sigmoid colon

Question 18

Indications for ileal conduit?

Answer 18

Bladder cancer
Neurogenic bladder
Bladder injury secondary to irradiation
Chronic pelvic pain

Question 19

Procedure indicated for right colon tumour? What is removed? What remains?

Answer 19

Right hemicolectomy

Remove from ileocaecal valve to first 3rd of colon

End ileostomy formed or primary anastomosis (join ileum to transverse colon)

Question 20

Procedure indicated for colon tumour, transverse or LHS? What is removed? What remains?

Answer 20

Left hemicolectomy

Remove from 2/3 transverse to sigmoid colon

Can form primary anastomosis - colocolic

Question 21

For extensive colonic disease what procedure may be indicated? What is left?

Answer 21

Panproctocolectomy - remove all colon from ileocaecal valve to rectum

• Form end ileostomy

Question 22

What does a total colectomy involve? What is left?

Answer 22

Removal of ascending, transverse, descending and sigmoid colon, leaving rectum.

Now can form J pouch to form anastomosis so no stoma required if successful -> ileal-pouch anal anastomosis

Question 23

What does a subtotal colectomy involve? What is left?

Answer 23

Removal of ascending, transverse and descending colon. Leaves sigmoid colon and rectum in situ.

Leaves end ileostomy and stump

Question 24

What does a Hartman’s procedure involve?

Answer 24

emergency procedure eg for diverticular perforation - remove sigmoid colon and rectum

Sigmoidectomy + end colostomy + rectal stump -> may later attempt anastomosis

Question 25

What procedure is indicated for a high lying rectal tumour?

What is formed?
What is left?

Answer 25

Anterior resection -> involves sigmoidectomy + top part of rectum removal

End colostomy is formed or can form defunctioning loop ileostomy and later attempt anastomosis

Question 26

What procedure is indicated for a low lying rectal tumour?

What is formed?

Answer 26

AP resection (abdominoperineal) -> anus to top of rectum removed

Form end colostomy