Surgical Treatment

Shany schwarzwald s1711

DR Cojocaru Cristina
• Acute appendicitis
• Intestinal occlusion
• Gastric ulcer
• Duodenal ulcer
• Abdominal wall hernia
• Acute cholecystitis
• Acute pancreatitis
• Peritonitis
• Trauma of the abdomen (hemorrhagic)
 Acute Appendicitis
Surgical management-
Appendectomy – Laparotomy
removes the appendix through a single incision long in the lower right area of the abdomen.
is about 2 to 4 inches (5 to 10 centimeters).
Than the appendix is removed and the wound is closed with stiches.
This procedure allows the doctor to clean the abdominal cavity .

New method-
laparoscopy appendectomy
a surgeon accesses the appendix through a few small incisions in the abdomen.
A small, narrow tube called a cannula will then be inserted.
The cannula is used to inflate the abdomen with carbon dioxide gas. For view the appendix more clearly.
when the abdomen is inflated, a laparoscope will be inserted through the incision.
The laparoscope is a long, thin tube with a high-intensity light and a high-resolution camera at the front.
The camera will display the images on a screen, allowing the surgeon to see inside the abdomen and guide the instruments.
When the appendix is found, it will be tied off with stiches and removed.
The small incisions are then cleaned, closed, and dressed.
Intestinal occlusion
PRINCIPLES:
- Management of segment at site of obstruction.
- Management of distended proximal bowel.
- Management of underlying cause of obstruction.

STEPS:
- Nasogastric intubation and suction.
- Anesthesia.
- Incision.
- Handling of the gut.
- Decompression of obstruction by savage decompressor within purse-string sutures OR resection
and anastomosis.
- Assess the viability of the bowel.
- Prevention of reperfusion injury.
- Closing of the abdomen.
Peptic ulcer
INDICATIONS FOR SURGERY
• refractory ulcers
• hemorrhage not responding to endoscopic treatment
• gastric outlet obstruction
• perforation
• suspicious of malignancy
Surgical option
• vagotomy - is a surgical procedure that removes part of your vagus nerve
• truncal and drainage
• selective
• highly selective
• posterior vagotomy and anterior seromyotomy
• gastrectomy
• billroth i
• billroth ii
• subtotal gastrectomy
• graham’s omental patch
• suture ligation of gastroduodenal artery
• undrer-running an ulcer base
• after excision of the edge
Abdominal wall hernia
Laparoscopic Surgery
Laparoscopic surgery is a surgical technique in which short, narrow tubes (trochars) are
inserted into the abdomen through small (less than one centimeter) incisions.
Through these trochars, long, narrow instruments are inserted.
The surgeon uses these instruments to manipulate, cut, and sew tissue.

Advantages
• Less post-operative pain
• Shortened hospital stay
• Faster return to regular diet
• Quicker return to normal activity
• Less wound infections
Acute cholecystitis
Early cholecystectomy for acute cholecystitis (usually within 48hrs)
-Laparoscopic
-Open
Elective cholecystectomy for biliary colic, chronic cholecystitis and some
asymptomatic stones
-Laparoscopic
-Open
-Endoluminal
Cholecystostomy is the best choice If patient is too sick or anatomy is deranged
-Percutaneous
-open
Peritonitis
Laparostomy
is a surgical treatment method in which the peritoneal cavity is opened
anteriorly and deliberately left open, hence often called 'open abdomen‘
for severe cases of peritonitis .
 Acute pancreatitis
For etiolgy
1. Cholecystectomy -is the surgical removal of the gallbladder.
2. ERCP – (endoscopic retrograde cholangiopancreatography) is a
procedure used to diagnose diseases of the gallbladder, biliary system,
pancreas, and liver.
3. CBD exploration - Common bile duct exploration is a procedure used
to see if something like a stone is blocking the flow of bile from your
liver and gallbladder to your intestine.
4. Longitudinal pancreatojejunostomy(Frey’s procedure and Puestow’s
procedure)
Cholecystectomy
• For gall stone pancreatitis.
• Defer till acute pancreatic inflammation resolve.
• If pre op ERCP is not done then during cholecystectomy intra op cholangio gram and CBD
exploration.

Endoscopic retrograde Cholangio pancreatogram

• For diagnosing choledocholithiasis.
• Simultaneous CBD clearance with or without papillotomy can be done.
Types
Open:
1. Debridement with closure over drains.
2. Debridement with closure over packing.
3. Debridement with closure over irrigation drains and postoperative lavage. Minimally invasive:

1. Laparoscopic/gastroscopic/nephroscopic necrosectomy
2. Radiology guided necrosectomy
Trauma of the abdomen (hemorrhagic)
penetrating trauma is more common than blunt trauma and the intestines are the most commonly
affected by penetrating and blunt trauma injuries.
Penetrating injuries
1. Anterior abdomen Between the anterior axillary lines; bound by the costal margin superiorly and the
groin crease distally
2. Thoracoabdominal area - Area delimited by the costal margin inferiorly and superiorly by the fourth
intercostal space anteriorly, sixth intercostal space laterally and eighth intercostal space posteriorly.
3. Flanks Bound by anterior axillary line and posterior axillary line, inferior costal margin superiorly to
iliac crests
4. Back Between posterior axillary lines extending from costal margin to the iliac crests
Laparoscopy :Most useful to eval penetrating wounds to thoracoabdominal region in stable pt ,esp for
diaphragm injury: Sens 87.5%, specificity 100%
Can repair organs via the laparoscope
diaphragm, solid viscera, stomach, small bowel.