Surg Med - Common Surgical Procedures - Exam 1

Resection

the removal by surgery of all or part of an organ or other body structure

Excision

 surgical removal of a piece of tissue or organ

Extirpation

surgical procedure where an organ or tissue is completely removed or eradicated

Debridement

removal of nonviable (dead), damaged, or infected tissue, foreign material, or debris from a wound to promote healing and reduce infection risk

Amputation

intestinal surgical removal of all or part of a limb or other body appendage by cutting through bone (or a joint), typically to treat disease, trauma, or severe infection

Anastomosis

surgical or natural connection between two tubular structures, such as blood vessels, intestines, or other hollow organs, allowing flow between them

Reanastomosis

surgical reconnection of two structures that were previously connected, then separated or disconnected (either surgically or due to injury)

Reconstruction

surgical restoration of the form and/or function of a body part that has been damaged, removed, or is abnormal, using techniques such as tissue rearrangement, grafts, flaps, implants, or prosthetics

Ostomy

surgical procedure that creates an opening (stoma) that connects a hollow internal organ to the surface of the body to allow the passage of waste, fluids, or air

Stoma

the opening on the body surface that connects to an internal organ, allowing the passage of bodily contents (such as stool, urine, or air) to the outside

Enterolysis

surgical lysis of adhesions involving the intestines, performed to free the bowel from abnormal fibrous bands that restrict movement or cause obstruction

Decompression

relief of abnormal pressure within a body compartment, organ, or system by removing or draining air, fluid, blood, or other contents, or by normal anatomy and flow

Detorsion

surgical untwisting of a structure that has become twisted on its axis (torsed) in order to restore normal anatomy and blood flow

Reduction

restoration of a displaced body part to its normal anatomical position (bony fractures, hernias)

Bypass

surgical procedure that creates an alternative pathway for the flow of blood, intestinal contents, or other bodily fluids around an obstructed, diseased, or nonfunctional segment

Diversion

intentional rerouting of the normal flow of bodily contents away from their usual pathway to an alternate route, often to protect, decompress, or allow healing of a downstream structure

Exteriorization

surgical technique of bringing an internal organ or segment of tissue outside the body (through the incision) so it can be directly visualized, treated, or temporarily positioned outside the body cavity

Billroth I (Gastroduodenostomy)

Gastroduodenostomy

Proximal remnant of stomas is re-anastomosed to duodenum after antrectomy

Has one limb

Not performed frequently due to possible obstruction

Billroth II (Gastrojejunostomy)

Gastrojejunostomy

Proximal remnant of stomach re-anastomosed to proximal jejunum after antrectomy

Has two limbs

Roux-en-Y Reconstruction

Jejunojejunostomy forming a Y-shaped figure of small bowel

The free end can be anastomized to a second hollow structure

gastrojejunostomy

stamm gastrostomy

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

Enables feeding and removal of air and fluids from the stomach

Needed when food can’t reach the stomach by normal means due to esophageal stricture, esophageal injury, or perforation

Highly Selective Vagotomy

Transection of vagal fibers to the body of the stomach without interruption of fibers to the pylorus

Does not need a pyloroplasty or other drainage procedure because the pylorus should still function

Nissen fundoplication

Used to treat refractory GERD and/or Barrett's Esophagitis

Reinforces closing function of the LES

-360 degree wrap of the stomach by the fundus around the distal esophagus to prevent reflux

Comp: post-op bleeding, gastric volvulus, hiatal hernia, esophageal stricture

Percutaneous Endoscopic Gastrostomy (PEG)

Endoscope is placed in the stomach which is then inflated with air

A needle is passed into the stomach percutaneously, string is passed through the needle transversing the abdominal wall and gastrostomy is then placed by using the Seldinger technique over the wire

Endoscopic version of Stamm gastrostomy

Heineke-Mikulicz pyloroplasty

Longitudinal incision through all layers of the pylorus, transverse closure to make the pylorus non-functional (after truncal vagotomy)

Graham Patch Repair

Placement of omentum with stitches over a gastric or duodenal perforation

Omentum used to plug the hole

Brooke ileostomy

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

Kocher Maneuver

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

To access posterior duodenum and pancreatic portion of common bile duct, mobilization of second and third portions of duodenum by incising the parietal peritoneum along descending duodenum and retracting it medially

Abdominoperineal Resection (APR)

Removal of the rectum and sigmoid colon through abdominal and perineal incision

Used for low rectal cancers less than 4-8 cm from the anal verge

Patient is left with a permanent colostomy

APR Abdominal Phase

Left colectomy, mobilization of the rectum, avoid left ureter and left gonadal vessel

APR Perineal Phase

Separate prostate from rectum in males and remove lower rectum, closure of anus

Low Anterior Resection (LAR)

Used when rectal cancers affect the proximal ⅔ of rectum

Colon is attached to the anus allowing for normal defecation

Hartmann's Procedure

Surgical resection of the rectosigmoid colon with closure of the rectal stump and colostomy

Used to treat colon cancer or diverticulitis

Use is limited to emergency surgery when immediate anastomosis is not possible

Used palliatively in colorectal tumors

Mucus Fistula

Can be the second of two stomas in a double barrel ostomy, or the second opening in a single loop ostomy stoma

Non-working stoma, it may discharge some mucus

Stoma #1: functioning part of colon; gas & stool excreted

Stoma #2: non-functioning end of colon and rectum

Exploratory laparotomy

Conditions that may be investigated:

Cancer, peritonitis, appendicitis, pancreatitis, abscesses, adhesions, diverticulitis, intestinal perforation, ectopic pregnancy, foreign bodies, internal bleeding

Puestow Procedure

Used in treatment of chronic pancreatitis

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

Pancreaticojejunostomy

Enterolysis (Lysis of Adhesions)

Surgical division or removal of intestinal adhesions

Formation can change normal anatomy and physiology of affected organ: Infertility, Ectopic pregnancy, Bowel obstruction

Lysis and restore normal anatomy and physiology

Choledochojejunostomy

Anastomosis of the bile duct to the jejunum

Used in treatment of selected patients with:

-Retained, recurrent, and impacted bile duct stones

-Strictures of the bile ducts

-Stenosis of the sphincter of Oddi

-Pancreatitis associated with biliary disease

-Choledochal cysts

-Fistulas of the bile duct

-Biliary obstruction (benign or malignant)

Appendectomy

Gold Standard for treatment of appendicitis is laparoscopy or laparotomy and appendectomy

McBurney's Incision

oblique incision dividing fascia parallel to its fibers, and a muscle-splitting technique

Rocky-Davis Incision

transverse incision in RLQ

used for appendectomy

Laparoscopic Cholecystectomy

Typically outpatient

Small periumbilical incision is made down to the fascia

Remove gallbladder

Open Cholecystectomy

Approach through a right subcostal incision

Dissection to isolate cystic duct and artery

Removal of gallbladder

Pringle Maneuver

A large hemostat is used to clamp the hepatoduodenal ligament interrupting the flow of blood through the hepatic artery and the portal vein and thus helping to control bleeding from the liver

Most useful in trauma and hepatic resections

Pancreaticoduodenectomy (Whipple)

Remove pancreatic head, distal duodenum, distal stomach, distal CBD, GB, and then re-anastomose

Cholecystectomy

Truncal vagotomy

Pancreaticoduodenectomy

Choledocojejunostomy

Pancreaticojejunostomy

Gastrojejunostomy

Whipple Procedure Indication

Operation is performed to treat: cancerous tumors of head of pancreas, malignant tumors involving CBD or duodenum near pancreas

Lumpectomy

Removal of breast mass and axillary lymph nodes

Normal surrounding breast tissue is spared

Patient usually undergoes post-op chemo/radiation

Simple mastectomy

Removal of entire breast tissue, sparing axillary contents

+/- resection of sentinel lymph node

Modified Radical Mastectomy

Removal of breast, nipple, and axillary lymph nodes, but no muscle is removed

Radical Mastectomy

Excision of the entire breast, axillary lymph nodes, and the pectoralis major and minor muscles behind the breast

Reserved for tumors involving pec major or recurrent breast cancer involving chest wall

Transurethral Resection of Prostate

Removal of obstructing prostatic tissue via scope in the urethral lumen

Femoral-Popliteal Bypass

Femoral artery to popliteal artery bypass

Using synthetic graft or saphenous vein

Used to bypass blockage in femoral artery

Carotid Endarterectomy

Removal of material on the inside of the carotid artery

Shunt may be placed

Seldinger Technique

a common medical procedure used to obtain safe access to a blood vessel or body cavity using a guidewire. It is widely used for placing central venous catheters, arterial lines, chest tubes, and other interventional procedures.

Thyroidectomy

Removal of the thyroid gland

Kocher's Incision

right subcostal incision for open cholecystectomy/RUQ surgery

Kidney Transplant Incision

lower quadrant, kidney is placed extraperitoneally

Liver Transplant Incision

Chevron or Mercedes Benz incision in the upper abdomen

Midline Laparotomy Incision

incision down the middle of the abdomen along and through the linea alba

Surgical work-horse in adults

McBurney's Incision

small, oblique, RLQ incision for an appendectomy through McBurney's Point

⅓ from the anterior superior iliac spine to the umbilicus

Paramedian Incision

used historically for splenectomies, appendectomies

Slightly off midline, not really used

Pfannenstiel Incision

low transverse abdominal incision w/ retraction of the rectus muscle laterally

Most often used in gyno surgeries

Sternotomy

vertical inline incision made along the sternum

Sternum divided with saw to provide access to the heart and lungs

Heart transplant, corrective surgery for CHD, CABG

Thoracotomy Incision

usually through 4th-5th ICS

May be anterior or posterior lateral incisions

Very painful

May be performed with muscle sparing

Muscle retraction, not muscle transection

Transverse Abdominal Incision

horizontal surgical incision made across the abdomen, typically following natural skin lines (Langer’s lines), which helps improve healing and cosmetic outcomes