Principles of Abdominal Surgery

Question 1

what approaches can be used to enter the body wall?

Answer 1

1. ventral midline
2. paramedian
3. flank

Question 2

layers of the body wall

Answer 2

1. skin
2. subcutaenous
3. body wall
4. peritoneum

Question 3

what is the most common way to enter the abdominal cavity?

Answer 3

ventral midline

Question 4

ventral midline

Answer 4

• skin
• subcutaneous
• linea alba: holding layer!
• peritoneum

Question 5

what is the holding layer for a ventral midline incision? why is this important?

Answer 5

linea alba! have to make sure it’s IN the closure, otherwise might get a hernia!
don’t want rapidly absorbing suture because it won’t stay long enough

Question 6

paramedian layers

Answer 6

• skin
• subcutaneous
• external rectus sheath= holding layer
• rectus abdominus muscle
• internal rectus sheath
• peritoneum

Question 7

what is the holding layer for a paramedian incision?

Answer 7

external rectus sheath, it is a little more vascular

Question 8

pros vs cons of paramedian incisions

Answer 8

• pros: good to do something on one side: pylorus access, incisional gastropexy, etc
• cons: hard to get to other side and can’t see well

Question 9

T/F: internal rectus sheath and peritoneum have no holding capacity

Answer 9

true

Question 10

flank incision layers

Answer 10

• skin
• subcutaneous
• external abdominal oblique fasica- holding layer!
• external abdominal oblique musclce
• internal abdominal oblique muscle
• transverse abdominus muscle
• peritoneum

Question 11

***what is the holding layer for a ventral midline incision?

Answer 11

linea alba!

Question 11

** what is the holding layer for a paramedian incision?

Answer 11

external rectus sheath

Question 12

** what is the holding layer for a flank/paralumbar incision?

Answer 12

external abdominal oblique FASCIA!!!

Question 13

what are the ideal sutures for body wall closure

Answer 13

absorbable (long lasting), and monofilament

Question 14

what suture is the strongest at the beginning?

Answer 14

biosyn!

Question 15

what suture loses its strength very quickly

Answer 15

monocryl

Question 16

what suture is ideal for bladder?

Answer 16

monocryl

Question 17

when should you use a surgeon’s throw in the abdomen?

Answer 17

only when tension requires it

Question 18

what is the best suture pattern for abdominal closures?

Answer 18

APPOSITIONAL!
- simple interrupted
- simple continuous- common
- cruciate - use with unhealthy tissue
- near far far near

Question 19

what are the appositional suture patterns used for abdominal surgery?

Answer 19

1. simple interrupted
2. simple continuous
3. cruciate
4. near far far near

Question 20

can you use everting sutures in abdominal surgery?

Answer 20

yes, but rare

Question 21

what are the everting sutures?

Answer 21

vertical mattress
horizontal mattress

Question 22

why not to use interrupted in abdominal surgery?

Answer 22

• time
• foreign material
• security

Question 23

when do you use near far far near in abdominal surgery?

Answer 23

if there is expected tension

Question 24

T/F: mattresses are good sutures to use in abdominal surgery if there is damaged/dead tissue

Answer 24

FALSE stay away from mattresses; want to avoid everting!

Question 25

where should you put your largest suture in abdominal surgery?

Answer 25

holding layer!

Question 26

where should you put your smallest suture in body wall closures?

Answer 26

subcutaneous to close dead space