7/1/2016
1
Lecture Outline
This lecture deals about the following items





Introduction to surgeries
Effects of anesthesia and Abdominal surgeries
Incisions for abdominal surgeries
Indications for abdominal surgery
Complications of surgeries
7/1/2016
2
Learning Objectives
At the end of This lecture student will be able to
 Explain different types of abdominal incisions
 Identify effects of anesthesia and Abdominal
surgeries
 Enumerate indications for abdominal surgery
 Explain Complications of surgeries
7/1/2016
3
General surgery is a surgical specialty that focuses on
abdominal contents including esophagus, stomach ,
small bowel, colon, liver, pancreas, gallbladder and
bile ducts. They also deal with diseases involving the
skin, breast, soft tissue, and hernia.
7/1/2016
4
1. Vertical incisions
• True mid line incision
• Paramedian incision
• Pararectal incision
2. Oblique incisions
3. Transverse incisions
7/1/2016
5
1. Vertical incisions
True mid line incision
o It doesn't bleed freely as
they are made through
fibrous tissue
o They are slower to heal
than other types
o They are used by
gynecologist below the
level of umbilicus
7/1/2016
6
1. Vertical incisions
Paramedian incisions
 Are commonly used
 Supra or sub umbilical
 About 1 inch from midline
7/1/2016
7
1. Vertical incisions
Pararectal incisions
• Just lateral to rectus
muscle
• Are rarely used since
nerves to the rectus
would be cut thus
grossly weakening
the muscle.
7/1/2016
8
2. Oblique incisions
Subcostal incision
 Run below the ribs
 RT ones would be
used for gall bladder
operations and LT
ones for splenectomy.
7/1/2016
9
2. Oblique incisions
Oblique lumbar incisions
 As for nephrectomy
 Extend further back at
lateral border of
sacrospinalis and pass
forward parallel with
12th rib toward anterior
superior iliac spine.
7/1/2016
10
2. Oblique incisions
McBurney’s incision
 Is commonly used for
appendectomy
 Mcburney ’s point is at the
junction of medial 2 thirds and
lateral 1 third of line joining the
umbilicus to anterior superior iliac
spine.
 The incision at the RT angle to the
line at this point.
7/1/2016
11
3. Transverse incisions
They are less
frequently used as they
may not give good
access although they
heal well.
7/1/2016
12
Vertical incisions
1. High incision near diaphragm ( deep breathing become
painful and lead to chest problems).
2. Full elevation of arm become painful.
3. With lower incisions, patient may find any early hip and
knee movements painful ( as abdominal muscle mainly
rectus acts as fixators during hip flexion).
4. Patients tends to keep leg without any movement that lead
to impairment of circulation of leg and may cause
phlebothrombosis
7/1/2016
13
Oblique incisions
 Patients may find the movements of rotation or side flexion to
opposite side painful.
 He tends to sit with spine side-flexed so the concavity toward
the side of the wound and leads to postural problems.
 High incisions affect diaphragm that may cause lung
complications.
 If incision is sever leads to extensive residual weakness of the
abdominal muscle.
 Full movements may be painful.
7/1/2016
14
Some certain suffixes of certain surgical procedures
 The suffix " ectomy" is derived from Greek word meaning "
cutting out"
 The suffix " oscopy" is derived from the Greek " to look"
and indicates an inspection of a hollow organ or body
cavity by means of an instrument devised for this purpose
 The suffix " ostomy" is derived from Greek word meaning
" mouth" and indicate therefore the making of an
opening.
7/1/2016
15
Some certain suffixes of certain surgical procedures
 The suffix " ography" indicates a written a description,
the process entails as a rule, the filling of the organ or
vessel with radio-opaque substance followed by x-ray
photographs of the part.
 The suffix " plasty" comes from Greek word meaning " to
mould" and is usually a suffix indicating that a certain tissue
is being repaired, remolded or built hence thus a
hernioplasty is a repair of hernial orifice
 Resection is derived from latin word re=again and secare =
to cut so indicate the operation of cutting out.
7/1/2016
16
It is an excision of gall bladder usually done to relieve the
symptoms of cholecystitis associated with gall stones,
laparoscopy is commonly used.
means surgical removal of the kidney, the procedure is
indicated when chronic disease or sever injury produces
irreparable damage to the renal cell. ( tumors, multiple cysts
and congenital anomalies may also necessitate removal of the
kidney).
7/1/2016
17
surgical excision of the thyroid gland, total thyroidectomy may
be performed in cases of cancer of the thyroid. Subtotal
thyroidectomy in which more than two thirds of the gland is
removed, is performed for certain patients suffering from
hyperthyroidism.
means excision of the stomach ( total gastrectomy ) or a portion
of it ( partial or subtotal gastrectomy) due to malignant tumors
or gastric ulcer that doesn’t respond to medical management or
is complicated by perforation or hemorrhage.
7/1/2016
18
surgical excision of the thyroid gland, total thyroidectomy may
be performed in cases of cancer of the thyroid. Subtotal
thyroidectomy in which more than two thirds of the gland is
removed, is performed for certain patients suffering from
hyperthyroidism.
means excision of the stomach ( total gastrectomy ) or a portion
of it ( partial or subtotal gastrectomy) due to malignant tumors
or gastric ulcer that doesn’t respond to medical management or
is complicated by perforation or hemorrhage.
7/1/2016
19
Masto means mammary gland or breast ; mastectomy is a
surgical removal of breast tissue usually performed to treat
malignant breast tumors. Also mastectomy equal to
mammectomy.
(Excision of vermiform appendix).
7/1/2016
20
• A minimally invasive approach to abdominal surgery where
rigid tubes are inserted through small incisions into the
abdominal cavity. The tubes allow introduction of a small
camera, surgical instruments, and gases into the cavity for
direct or indirect visualization and treatment of the
abdomen. The abdomen is inflated with carbon dioxide gas
to facilitate visualization and, often, a small video camera is
used to show the procedure on a monitor in the operating
room. The surgeon manipulates instruments within the
abdominal cavity to perform procedures
7/1/2016
21
The term abdominal surgery broadly covers surgical
procedures that involve opening the abdomen.
The most common abdominal surgeries are
 Appendectomy is Surgical opening of the abdominal cavity
and removal of the appendix.
 Caesarean section (also known as C-section) is a surgical
procedure in which one or more incisions are made
through a mother's abdomen (laparotomy) and uterus
(hysterotomy) to deliver one or more babies
 Inguinal hernia surgery, This refers to the repair of
an Inguinal hernia
7/1/2016
22
The most common abdominal surgeries are
Exploratory Laparotomy This refers to the opening of
the abdominal cavity for direct examination of its contents,
for example, to locate a source of bleeding or truma. It may or
may not be followed by repair or removal of the primary
problem.
Laparoscopy- A minimal invasive approach to abdominal
surgery where rigid tubes are inserted through small
incisions into the abdominal cavity. The tubes allow
introduction of a small camera, surgical instruments, and
gases into the cavity for direct or indirect visualization and
treatment of the abdomen.
7/1/2016
23
Laparoscopy cont.
The abdomen is inflated with carbon dioxide gas to facilitate
visualization and, often, a small video camera is used to show
the procedure on a monitor in the operating room. The surgeon
manipulates instruments within the abdominal cavity to perform
procedures such as cholecystectomy (gallbladder removal), the
most
common
laparoscopic
procedure.
The
laparoscopic
method speeds recovery time and reduces blood loss and
infection
as
compared
to
the
traditional
"open“
cholecystectomy.
7/1/2016
24
Complications of abdominal surgery include, but are not
limited to:
• adhesion (also called scar tissue): Complications of
postoperative adhesion formation are frequent, they have
a large negative effect on patients’ health.
•bleeding
•infection
•Paralytic ileus (sometimes called ileus): short-term
paralysis of the bowel.
•shock
7/1/2016
25
Lunca S, Bouras G, Stanescu AC (2005). "Gastrointestinal robot-assisted
surgery. A current perspective". Romanian journal of gastroenterology 14 (4):
385–91.
Broek R, Issa Y, Van Santbrink E, Bouvy N, et al. (2013). "Burden of adhesions in
abdominal and pelvic surgery: systematic review and met-analysis". BMJ 347: f5588
7/1/2016
26
7/1/2016