General Surgery Notes

General Information on General Surgery

  • Overview of General Surgery
    • Involves multiple organ systems, primarily focusing on the abdominal cavity and its contents.
    • General surgeons perform procedures on various tissues and organs.
    • This chapter covers procedures essential for a basic understanding of general surgery rotations.

Routine Equipment in General Surgery

  • Essential Surgical Equipment:

    • Electrosurgical unit (ESU) with patient return electrode and foot pedal.
    • Harmonic scalpel and LigaSure.
    • Suction apparatus for fluid removal.
    • Headlamp for surgeon's use.
    • Laser for specific procedures, like hemorrhoidectomies.
    • Cell-Saver for blood recovery.
    • Hypo-/hyperthermia unit, used selectively.
    • Forced-air warming devices to maintain body temperature.
    • Intermittent venous compression devices and boots for patients at risk for deep vein thrombosis.

  • Laparoscopic Procedures:

    • Requires additional equipment:
    • Video tower (monitor, insufflator, camera, light source, still photography printer, and recording device).
    • "Slave" monitor for dual viewing.
    • Carbon dioxide source for insufflation.

Surgical Instrumentation

  • Types of Instrumentation:
    • Laparotomy set: Fundamental for many surgeries.
    • Minor and Major sets: Different instruments for varying complexity of procedures.
    • Includes intestinal and biliary instruments.

Types of Surgical Incisions

  • Factors Influencing Incision Type:
    • Access required for the procedure.
    • Surgeon’s personal preference.
    • The feasibility of extending the incision if needed.
    • Security and healing characteristics of the incision.

Laparotomy

  • Defined as a surgical incision through the abdominal wall into the peritoneal cavity.
    • Different types include exploratory laparotomy.

Surgical Procedures in the Alimentary Canal

  • Surgery Overview:

    • General surgeons frequently operate on the digestive system, particularly the alimentary canal.

  • Esophageal Pathology:

    • Major conditions affecting the esophagus include:
    • Hiatal hernia and reflux esophagitis
    • Esophageal motility disorders
    • Neoplasms (tumors)
    • Trauma to the esophagus.

Gastrectomy Procedures

  • Laparoscopic Nissen Fundoplication:

    • Used primarily to correct hiatal hernia.

  • Gastrostomy:

    • Surgical creation of an opening from the gastric mucosa to the skin.
    • Used for nutrition provision and stomach decompression.

  • Total Gastrectomy:

    • Entire stomach removal with reconstitution of the alimentary tract.
    • Subtotal Gastrectomy Types:
    • Billroth I: Pylorus removal, end-to-end anastomosis between remaining stomach and duodenum.
    • Billroth II: Closure of cut duodenal ends and jejunum's anastomosis to stomach.

Bowel Surgery

  • Pathological Conditions of Bowel:

    • Focus on various conditions affecting both the large and small intestines.

  • Appendectomy:

    • Procedure for acute appendicitis, can be performed prophylactically during other surgeries.

  • Stomas:

    • Deviation of a bowel section to the outer abdominal cavity for fecal diversion.
    • Used to protect recent bowel resection or manage post-operative complications.

Anorectal Surgery

  • Pathological conditions present various signs and symptoms in the anorectal area.

Liver and Biliary Tract Surgery

  • Liver Pathology and Conditions:

    • Diagnosis through patient history, physical examination, lab data, imaging, and biopsy.
    • Surgical resection commonly performed for hepatocellular tumors or other severe conditions.

  • Cholecystectomy:

    • Removal of the gallbladder primarily for acute cholecystitis.
    • 90% of procedures done laparoscopically with a 95% success rate.

Surgery of Pancreas and Spleen

  • Pancreatectomy and Whipple Procedure:
    • The Whipple procedure (pancreaticoduodenectomy) is crucial for tumors at the head of the pancreas, requiring resection and reconstruction due to shared arterial supply with the duodenum.

Hernias

  • Definition and Types:
    • Hernias are the protrusion of an organ through a cavity wall. Types may be internal, interparietal, or external, and can arise from congenital or acquired causes.

Breast Surgery

  • Breast Cancer Treatment:

    • Multidisciplinary approach emphasized for effective treatment of breast cancer, which affects mostly females.

  • Modified Radical Mastectomy:

    • Removal of the entire breast and axillary lymph nodes for certain stages of breast cancer.

Thyroid and Parathyroid Surgery

  • Thyroidectomy:
    • Involves careful removal of the thyroid gland to avoid damage to the parathyroid glands, which if completely removed, may lead to hypoparathyroidism and symptoms like tetany.

Summary

  • This chapter encapsulates essential preoperative preparation, instruments and supplies used in general surgery, specific surgical procedures, and immediate postoperative care including possible complications.