Surgical Scars and Colonic Resection Mushkies Flashcards
When is a midline laparotomy incision used?
- Emergency = Perforated DU, Trauma, Ruptured AAA, Hartmans
- Elective = Colectomy, AAA, Vascular Bypass
When is a right paramedian incision used?
Not commonly used now as closure techniques have improved
When is a Kocher’s (subcostal) incision used?
- Open cholecystectomy
2. A L Kocher’s is used for a splenectomy
When is a rooftop incision used?
- Oesophageal surgery e.g. oesophaegectomy
- Gastric surgery e.g. gastrectomy
- Bilateral Adrenalectomy
- Liver Resection
- Liver Transplant
- Whipple’s
What is a Whipple’s procedure?
A pancreatico-duodenectomy, performed to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct.
When is a Pfannenstiel incision used?
- Gynae surgery = LSCS, hysterectomy, oopherectomy
2. Lower Urinary Tract surgery
What incisions are used for an appendicectomy?
McBurney's = Oblique Lanz = Transverse
Why is a Lanz incision preferred over a McBurney’s incision?
As it is hidden in the natural skin crease
When is a thoracoabdominal incision used?
Oesophago-gastrectomy
When is a Transverse Muscle Splitting incision used?
Right Hemicolectomy
What incision is used for a right hemicolectomy?
A Transverse Muscle Splitting incision
When is an inguinal incision used?
- Open inguinal hernia repair
2. Orchidectomy
What is half a Pfannenstiel scar called?
When is it used?
McEvedy incision for an Emergency femoral hernia
When is a loin incision made?
Nephrectomy
What are vascular access scars used for?
- Bypass
- Embolectomy
- EVAR/TEVAR
- Stent insertion
- Femoral Endarterectomy
- Angioplasty
What system can you use when discussing colonic resections?
DIS SAD
- Definition/Description
- Indication
- Scars
- Stoma
- Anastomosis
- Differential
What is a right hemicolectomy?
D = surgical resection of the ascending colon with subsequent formation of an ileocolic anastomosis I = tumours in the caecum and proximal ascending colon S = midline laparotomy, transverse muscle splitting, laparoscopic ports S = none A = ileocolic D = midline laparotomy differential
What is an extended right hemicolectomy?
D = surgical resection of the ascending colon with extension of the distal resection margin to the splenic flexure, with subsequent formation of an ileocolic anastomosis I = tumours in the distal ascending colon or transverse colon S = midline laparotomy, laparoscopic ports S = none A = ileocolic D = midline laparotomy differential
What is a left hemicolectomy?
D = surgical resection of the transverse colon left of the middle colic vessels to the level of the upper rectum, with subsequent formation of a colocolic anastomosis I = tumours in the descending colon S = midline laparotomy, laparoscopic ports S = none A = colocolic D = midline laparotomy differential
What is a Hartmann’s procedure?
D = surgical resection of the rectosigmoid colon with the formation of an anorectal stump and an end colostomy I = Obstruction or perforation secondary to sigmoid tumour or diverticulitis S = Midline laparotomy, ?stoma scar in LIF with reversal S = single lumen colostomy in the LIF A = none D = AP resection
What is an Abdomino-Perineal Resection?
D = surgical resection of the anus, rectum, and part of the sigmoid colon with formation of an end colostomy I = rectal Ca <4-5cm from anal verge S = Midline laparotomy, no anus S = single lumen colostomy in the LIF A = none D = Hartmann's procedure
What is an Anterior Resection?
D = surgical resection of part of the rectum and sigmoid colon, may be high or low depending on site of the tumour + total mesorectal excision for tumours in the middle or lower 1/3rd
I = rectal Ca >4-5cm from anal verge
S = midline laparotomy, laparoscopic ports, scar/stoma in RIF
S = double lumen loop ileostomy in the RIF
A = Colorectal
D = End Ileostomy (panproctocolectomy (UC,FAP), subtotal colectomy (acute severe UC), cystectomy and ileal conduit) or Loop Ileostomy (for e.g. Anterior Resection or Crohns)
Additional Mushkie: Rectal blood supply is poor, therefore the colorectal anastomosis is covered by a temporary loop ileostomy
What is a Subtotal Colectomy?
D = surgical resection of the entire colon except for distal sigmoid and rectum, rectosigmoid stump may be exteriorised as a mucous fistula
I = acute severe UC
S = midline laparotomy, laparoscopic ports
S = single lumen (temporary) end ileostomy in the RIF
A = none
D = End Ileostomy (panproctocolectomy (UC,FAP), subtotal colectomy (acute severe UC), cystectomy and ileal conduit) or Loop Ileostomy (for e.g. Anterior resection or Crohns)
Additional Mushkie: Followed after 3m by either a completion proctectomy + IPAA or permanent end ileostomy OR an ileorectal anastomosis
What is a Panproctocolectomy?
D = surgical resection of the entirety of the colon, rectum and anus with formation of a permanent end ileostomy I = UC or FAP S = midline laparotomy, laparoscopic ports S = single lumen end ileostomy in the RIF A = none D = End Ileostomy (panproctocolectomy (UC,FAP), subtotal colectomy (acute severe UC), cystectomy and ileal conduit) or Loop Ileostomy (for e.g. Anterior resection or Crohns)
