Describe the indications for cholecystectomy
- Symptomatic gallstones (biliary colic)
- Acute cholecystitis or cholangitis
- Gallstone pancreatitis (delayed)
Describe the procedure for cholecystectomy briefly with reference to key anatomy
Usually laparoscopic
- Identify Calot’s triangle (cystic duct, hepatic duct, free liver edge)- important to ensure correct ligation of cystic artery
- Dissect and ligate cystic duct + cystic artery
- Removal GB
Describe the complications of cholecystectomy
Surgical: bile leak, damage to surrounding structures (eg hepatic artery), bleeding, conversion to open
Anaesthetic: N+V, sore throat, muscle aches, allergy/anaphylaxis, death
Short term post-op: pain, wound infection, DVT
Long term post-op: adhesions, recurrence of gallstones, steatorrhoea
Describe the indications for gastrectomy
- Gastric malignancy
- Bariatric surgery
- Peptic ulcer
Describe the complications of gastrectomy
Surgical: damage to surrounding structures
Anaesthetic
Immediate post-op: bleeding, wound infection, pain, anastomotic leak
Long-term post-op: dumping syndrome, diarrhoea, vitamin deficiency, small stomach syndrome, adhesions
Describe the post-op care for gastrectomy
Immediate:
- NBM, IV fluids/TPN for 1-2 weeks
- NGT + suction
Long-term:
- Vitamin supplementation (B12, iron)
- Small frequent meals, low dairy
What are the types of gastrectomy?
- Partial
- Total
- Sleeve (remove left side)
- Oesophagogastrectomy
Describe the indications for Nissen fundoplication
In following conditions when severe/not responding to medical Mx: -Severe GORD -Barrett's oesophagus -Hiatus hernia To reduce acid moving up the oesophagus
Describe the procedure of fundoplication
Laparoscopic
- Narrow the oesophageal hiatus
- Wrap the fundus of the stomach around the lower oesophagus
Describe the complications of fundoplication
Surgical: damage to surrounding structures
Anaesthetic: see elsewhere
Short term post-op: pain, bleeding, infection, DVT
Long-term post-op: dysphagia, failure to control symptoms, adhesions
Describe the post-op care of fundoplication
- May go home same/next day
- Soft food diet for first 1-2 weeks
Describe the indications for oesophagectomy
-Oesophageal malignancy
Describe the types of oesophagectomy
- Ivor Lewis: abdo incision + right thoracotomy. Middle third tumours
- Minimally invasive: w laparoscopy + thoracoscopy
- Transhiatal: only neck and abdo incision
- McKeown: upper third tumour. Three incision.
Describe the procedure of oesophagectomy briefly
Resect the tumour area
Mobilise stomach into chest
Anastomose the distal oesophagus to stomach
Describe the post-op care for oesophagectomy
Diet: clear liquid -> liquid -> soft food -> normal diet
Jejunostomy tube until eating normally eg. 4-6 weeks
Describe the complications of oesophagectomy
Surgical: bleeding, recurrent laryngeal nerve damage
Anaesthetic
Short term post-op: pain, wound infection, DVT, anastomotic leak
Long term post-op: dumping syndrome, weight loss, GORD, dysphagia, recurrence, adhesions
Describe the indications for splenectomy
- Splenomegaly
- Ruptured spleen
- Haematological malignancy
- Abscess
Describe the complications of splenectomy
Intra-operative: bleeding, damage to surrounding structures
Anaesthetic
Short term post-op: pain, wound infection/dehiscence, DVT
Long term post-op: adhesions, infections (encapsulated bacteria)
Describe the indications for Whipple’s procedure
Pancreatic lesions: cancer, cysts
Cholangiocarcinoma
Describe the process of a Whipple’s procedure (briefly)
Open surgery (Chevron, midline)
- Dissect + move pancreas
- Remove the antrum to duodenum + head of pancreas + GB
- Anastomose stomach and jejunum
- Attach pancreas to free end of jejunum
Describe the complications of a Whipple’s procedure
Intra-operative: bleeding, damage to surrounding structures
Anaesthetic
Short term post-op: wound infection, bile leak, DVT, pancreatitis
Long term post-op: DM, recurrence, delayed gastric emptying
Describe the complications of rectal prolapse repair
Intra-operative: bleeding, damage to surrounding structures
Anaesthetic
Short term post-op: wound infection, DVT, pain, bowel obstruction
Long term post-op: recurrence, fistula, sexual dysfunction, mesh complications
Describe the process of rectal prolapse repair
Can be open/lap abdominal approach (rectopexy) or perineal
Abdo: use sutures/mesh sling to attach rectum to sacrum
Delorme: shorten rectum by removing mucosa
Altemeier: resect rectum segment + anastomose to sigmoid colon
Describe the pros and cons of open vs laparoscopic abdominal surgery
Open:
- Pros: better exposure, allows full resection/removal of large structures
- Cons: longer recovery time, higher rate of complications (wound infection, pain, bleeding)
Laparoscopic:
- Pros: smaller scars, decreased risk of complications, shorter recovery
- Cons: may not be practical (eg. inserting large stents), reduced visibility, not used in emergencies
