Surgical Procedures

Colostomy/ileostomy (ostomies) indications

-relief of obstruction (colonic)
-protects distal anastomosis
-emergent where primary anastomosis is not feasible
-low rectal or anal CA not amendable to anastomosis

Colostomy/ileostomy (ostomies) complications

-ostomy retraction, prolapse, necrosis, obstruction (fascia too tight)
-skin irritation, infection, cellulitis
-parastomal hernia
-necrotizing soft tissue
-dehydration (only w/ high output ileostomy)

Left Laparoscopic colectomy indications

-CA of sigmoid
-volvulus
-large endoscopically unresectable polyp of L colon
-diverticular disease/stricture
-ischemic colitis
-IBD
-refractory lower GI bleed to endoscopy/radiographic intervention

In a Left Laparoscopic colectomy we need to avoid which anatomical features due to their proximity?

ureter, splenic flexure injury

Left Laparoscopic colectomy complications

-leak
-intraabdominal abscess
-surgical site infection
-dehiscence
-ileus
-stricture of anastomosis
-damage to other structures
-fistulas

Right Laparoscopic colectomy indications

-CA of appendix, cecum, R colon
-large unresectable polyp of R colon
-volvulus
-R sided diverticular disease
-IBD
-carcinoid tumor
-perforations

In a right Laparoscopic colectomy we need to avoid which anatomical features due to their proximity?

ureter and duodenum

Right Laparoscopic colectomy complications

same as L colectomy

Laparoscopic appendectomy indications

acute appendicitis

In a laparoscopic appendectomy we need to make sure the bladder is empty whether the pt voids b4 operation or a catheter is placed bc a full bladder can do what?

hinder dissection and can be injured during the procedure

laparoscopic appendectomy complications

-abscess (intraabdominal)
-stump appendicitis
-appendiceal stump leak
-surgical site infection
-injury to other organs
-ileus

Laparoscopic cholecystectomy indications

-cholecystitis
-gallstone pancreatitis (once pancreas is involved)
-choledocholithiasis (post CBD stone removal)
-symptomatic cholestasis
-intractable biliary colic
-GB polyps
-part of Whipple procedure (open surgery)

what is used to cut between the clips placed on the cystic duct/artery in a laparoscopic cholecystectomy? Why is this important?

laparoscopic scissors bc cautery can never be used as it can cause an electrical arch that may result in a fire

laparoscopic cholecystectomy complications

-CBD injury
-bile leak from liver or cystic duct (clip malfunction > bile peritonitis)
-abscess
-retained CBD stone
-duodenal injury
-wound infection
-ileus

Laparoscopic inguinal hernia repair (total extraperitoneal) indications

inguinal hernia

Laparoscopic inguinal hernia repair (total extraperitoneal) complications

-injury to the epigastric vessels (life threat > expanding hematoma > groin exploration)
-Injury to the spermatic cord or vas deferens
-Hematoma/bleeding
-Neuropathic pain (from nerve tack)
-Numbness if the nerve had to be sacrificed

Laparoscopic inguinal hernia repair (total extraperitoneal) post op considerations

post op urinary retention is common

Open Inguinal Hernia Repair (With Mesh) indications

inguinal hernia (+/- with other comorbidities that preclude them from general anesthesia > given only in case of incarceration or strangulation)

In an Open Inguinal Hernia Repair (With Mesh) we need to avoid which anatomical features due to their proximity?

ilioinguinal nerve

Open Inguinal Hernia Repair (With Mesh) complications

-damage to vas deferens/other cord structures
-neuralgia if nerve trapped in mesh
-numbness if ilioinguinal/genitofemoral nerve injured
-hernia recurrence
-groin hematoma
-hemorrhage if injury to epigastric vessels