Specific Surgeries Flashcards
(35 cards)
What is a Nissen Fundoplication?
A complete 360 wrapping of the fundus of the stomach around the lower OG sphincter
The right crus of the diaphragm is also tightened
What are the Complications of a Nissen Fundoplication?
Can be done too tight Not able to burp or vomit Excess wind (Gas Bloat Syndrome) Dysphagia Diarrhoea
What other surgeries can you do for Hiatus Hernias/GORD?
Anterior/Posterior Wrap
Sympathectomy
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Surgery for Oesophageal Cancer?
Removal of the affected part and using the stomach or small bowel as an oesophagus
What is ERCP?
Enterograde retroscopic cholangiopanceatography
X Ray guide imaging of the bile ducts and can use it to remove bile stones, image obstructions, balloon dilatation and stent the ducts
What are the risks of ERCP?
Perforation
Pancreatitis
Worsen the obstruction
How do you treat a gastric cancer surgically?
Roux en Y procedure
Gastrectomy (in proximal)
Subtotal Gastrectomy (if pylorus/antrum)
What is a roux en Y?
Bypassing the stomach and attaching the oesophagus to the small bowel
The duodenum is closed off proximally, but attached to the small bowel so bile can flow
What are complications of a roux-en-Y?
Dumping syndrome
B12 deficiency
Anastomotic Leak
Death
What is dumping syndrome?
How do you avoid it?
Where partial undigested (hyperosmotic) food e.g. sugars passes into the duodenum causing lots of H2O influx
Leads to pain, distention
Can also cause large increase of insulin causing hypoglycaemia, hypokalaemia
Small meals
Avoid certain foods
Drink with meals
What is a gastric sleeve?
When part of the stomach is banded or sewn off to create a smaller stomach (sleeve)
It is a weight loss procedure
Can have the same complications as REY
How do you treat a hernia surgically?
You remove the hernia from its hole created and do a mesh repair
What are the mesh options?
Nylon
Polypropylene
Biomesh
What is a Whipple’s procedure?
A pancreatoduodenectomy
Removal of those parts due to pancreatitis (chronic), pancreatic cancer. Normally leave the tail/body of the pancreas and reattach it to preserve function
It is normally palliative
What is a possible complication of a Whipple’s?
Pancreatic Fistula
What is a Hartmann’s Procedure?
Emergency resection of the sigmoid colon
Normally forms a end colostomy and a rectal stump.
Can be reversed.
Not anastomosed at the time due to risk of leakage
Why do a Hartmann’s procedure?
Acute perforation or obstruction
What is a Hemicolectomy?
Types?
Why?
Removal of one portion of the bowel and its associated mesentery (with artery, vein and lymph nodes that supply it)
Normally due to malignancy, can due due to UC or any other cause of obstruction/perforation
Right (SMA)
Left (IMA and Left Middle Colic)
Extended right (if problem is in transverse colon)
Sigmoidectomy (IMA all removed)
What can you do following a hemicolectomy?
Re-anastomose
End colostomy or ileostomy
Covering stoma (for bowel rest, can be reversed)
What is an Anterior resection
Resection of the rectum, if problem/cancer is over 5cm away from the anus
Leaves sphincter intact and can anastomose
Can be a low or high approach
What is an AP resection?
Abdominoperineal resection
If the malignancy is <5cm away from anus
Removal of the sigmoid, rectum and anus
Form a permanent end colostomy
What is a Total Colectomy?
Why is it different from a Pan Proctocolectomy?
Total is emergency - removal of everything except the rectum and anus, can later from an ilioanal pouch
PP is non emergency, it also removes the rectum and anus and has a permanent iliostomy
When do you do a PP or Total Colectomy?
In UC, Crohn’s, FAP
What is an ilioanal pouch?
When an anastomosis is formed between the terminal ileum and the anus
The ileum is formed into a J shape and attached to the anal canal
