Gastic and Intestinal Surgery

Gastric Surgery
Pathological Conditions
of the Stomach
These conditions include:
Gastric Ulcer Disease
Gastritis
Gastric Polyp (rare)
Bezoar (mass of indigestible veg fiber)
Carcinoma
Lymphoma
Gastric Procedures
Gastrostomy
The creation of a fistula tract from the gastric mucosa to the skin
Gastrostomy
(continued)
This procedure is performed to provide nutrition (feeding tube) or for decompression of the stomach.
It can be done for a short term or long term placement
The procedure can be done open or as a percutaneous puncture assisted with an EGD
Procedures Related to Gastric Secretion, Ulcers, and Neoplasm
Vagotomy
A vagotomy is the severing of the vagal nerve which interrupts the secretion of gastric acid.
Three variations
Truncal
Selective
Proximal (parietal)
Pyloroplasty
The reconstruction of the pyloric sphincter
Gastrectomy
Total
Partial
Antrectomy
Gastroduodenostomy
Billroth I and II
These are both antrectomies
Billroth I is with a reanastomosis to the duodenum
Billroth II is with a reanastomosis to the jejunum
Gastroduodenostomy
Billroth I
Procedures for Morbid Obesity
Open Gastric Stapling
Roux-en-Y Gastric Bypass
Laparoscopic Banding
Small Bowel Surgery
Pathologic Conditions of the Small Bowel
Meckel’s diverticulum
Benign neoplasm
Malignant neoplasms
Obstructions
Crohn’s disease
Common Features of Resection and Anastomosis
Supine position
General anesthesia
Margins of resection selected
Mesentery inspected
Mesenteric window created
Mesenteric resection
Colon resected
Anastomosis Options

End-to-end
End-to-Side
Side-to-Side
Colon Surgery
Diagnostic Testing
Colectomies
Right Colectomy
Right Hemicolectomy
Transverse Colectomy
Left Colectomy
Left Hemicolectomy
A/P Resection
Stomas
Iliostomy / Colostomy
Types of Stomas
End ileostomy
End loop ileostomy
End Colostomy
End Loop colostomy
Sigmoid colostomy
Anorectal Surgeries
Anorectal Surgeries
Anesthesia
Pt position
Anal Fistulas
Purulent tract
Four types
Intersphincter
Transsphincter
Suprasphincter
Extrasphincter
Anal Fistulas
Fistulotomy
Vs.
Fistulectomy
Pilonidal Fistula
More commonly called a pilonidal cyst
Pilonidal Cystectomy
Z-plasty

Hemorrhoids
O-rings
Excision
Sharp dissection
CO2 laser

Reading Assignment for next Class
ST for the ST
Surgery of the Liver and Biliary Tract
Pages 333-349
Alexander’s
Surgery of the Liver and Biliary Tract
Pages 404-418
Starting with Positioning the Patient on 404