PHTY205 - Abdominal & Vascular Surgery

ectomy

removal of something

oscopy

view with scope

ostomy

form a new opening

ontomy

cut into

plasty

form/surgical repair

how is type of surgery described

Site

• Thoracic

• Cardiac

• Abdominal

• ENT/head & neck

• Neurological

• Peripheral

Structure

• Colo-rectal

• Hepato-biliary

• Vascular

• Gynaecological

Access

• Minimally invasive (-scopic)

• Open

keyhole surgury

minimally invasive

It:

• Can be used for diagnosis or treatment

• Uses small incisions

• A tube containing a video camera is inserted to allow the surgeon to see the area.

Named depending what part of body is involved:

open surgery advantages vs disadvantages

Advantages: thorough; good access

Disadvantages: GA/operation time

Larger wound

Less mobile

More analgesia required

laparoscopic surgery advantages vs disadvantages

Advantages: 3 ports → less invasive

Less time in theatre

Less pain/analgesia

Generally earlier discharge

Disadvantages: insufflation/pain

Unseen complications such as bleeding/fistula

eras aims

↓ surgical trauma + ↓ postoperative pain + ↓ complications + ↓ hospital LOS + improve outcomes + expedite recovery

eras 4 key principles

1. Pre-operative education

2. Nutrition optimisation

3. Anaesthetic/analgesic regimens

4. Early ambulation

indications for abdominal surgery

• sepsis

• malignancy

• trauma

• bariatric surgery

• inflamatory disease

• vascular

upper GI surgery types

• Cholecystectomy

  • Removal of gall bladder

• Gastrectomy

  • Total

  • Partial

• Whipple procedure

  • Pancreaticoduodenectomy

lower GI surgery

• Anterior resection

• Hemicolectomy

• Abdominoperineal resection

• Colostomy

bariatric surgery

• Laparoscopic gastric banding

• Sleeve gastrectomy

• Roux-en-Y gastric bypass

patient considerations for bariatric surgery

This patient group commonly has a high number of co-morbidities, including:

• Diabetes

• MSK issues

• Obstructive sleep apnoea (OSA)

Patients are often:

• Deconditioned

• In need of rehabilitation.

They may also require specialised:

• Beds

• Mobility aids

• Other equipment.

Abdominal Aortic Aneurysm — AAA - what

dilation of abdominal aorta greater than 3c,

Presentation

• Often an incidental finding

• Signs/symptoms:

  • Pulsating abdomen

  • Back pain

Major concern

Rupture = medical emergency.

AAA repaire types

open

endovascular

AAA repaire open

• Large abdominal incision

  • Full-length midline OR

  • Wide transverse

• Provides access to the entire abdominal cavity.

• Aorta is clamped above and below the aneurysm.

• Surgical graft is sewn in.

• Aorta is closed over the graft.

AAA endovacular repaore

minimally invasive

• Stent graft inserted into the aneurysm

• Accessed through small incisions in the groin.

PCC

Emergency AAA repair

This is the highest cohort of patients to experience PPCs.

PCC results in

↑ morbidity/mortality + ↑ LOS + ↑ readmission + ↓ QOL/function + ↑ 12-month mortality

Non-Pulmonary Complications of Abdominal Surgery

• Cardiovascular instability

• Haemorrhaging

• Myocardial infarction

• DVT/PE

• Operative embolisation

• Infection

• Wound dehiscence

• Dehydration

• Low urine output

• Acute renal failure/kidney injury

• Paralytic ileus

• Nausea & vomiting

• Musculoskeletal complications

Delirium.

vasular surgury - Angioplasty ± Stenting

• Catheter inserts a small balloon

• Balloon inflated inside vessel

• Compresses plaque against vessel wall

± stent inserted to keep vessel open

vasular surgery - atherectomy

• Catheter mechanically removes plaque from a blood vessel.

• Can use:

  • Rotating blade

  • Grinding bit

  • laser

vasuclar surgery - endarterectomy

Open surgery to remove plaque from the inner wall of a diseased vessel.

vascular surgery = bypass graphting

• Homografts (form another place)

• Dacron grafts. (synthetic)

Non-Pulmonary Complications of Vascular Surgery

Haemorrhage

Can occur:

• Intra-operatively

• Post-operatively

May cause:

Haemodynamic instability

Other complications:

• Operative embolisation

Vascular graft infections

Cardiovascular Disease Consequences of vascular surgery

• Stroke (CVA)

  • Carotid atheroma → emboli

• Heart attack (MI) / heart failure

• Aortic aneurysm

  • → rupture

• Renal failure

• PVD

  • → ischaemia

→ gangrene