Transactions in abdominal

To check the free flow of the outer portion of the drainage applied periodically clamp, if it does not cause pathological symptoms (pain), drainage removed 16-18 days fistula closes spontaneously.

Audit ductus choledochus, removing stones and draining it can be done and after removing the bladder through the cystic duct stump, in the event that the ligature does not impose on the stump.

Overlay a fistula of the gallbladder

Indications. The same as for cholecystectomy. The operation is performed in elderly patients suffering from degeneration of parenchymal organs, heart and lung failure, and in severe cholecystitis, accompanied by sharp local inflammatory phenomena, such as the minimum acceptable intervention in such circumstances. The aim of the operation - the creation of the outflow of bile and for the inflammatory exudate from the bladder.

Pain relief. Local anesthesia, anesthesia.

The surgical procedure. The abdomen was opened, the bottom of the gall bladder carefully isolate the gauze. Hold the two opposite walls of the bladder clamp, suction puncture the contents and then cut through the wall. Through the hole remove gallstones. Check the presence of stones in the ducts (especially in the neck of the bladder) and remove them.

Bubble washed and added thereto drainage (rubber catheter diameter of 8-10 mm), which is fixed a silk suture to the edge section of the bladder. Around the hole in the wall of the bladder in addition impose a purse-string suture. When tightening the plot with bladder drainage screw inserted inside. The ends of both lines - and the fixing of the pouch - trimmed. Drainage is discharged outside through the abdominal wound. The wall around the bladder drainage fix one catgut sutures to close the cut edges of parietal peritoneum and aponeurosis. On the other extent the surgical wound is sutured in layers.

Some surgeons do not recommend hemming bubble to the parietal peritoneum, fearing that the bladder can cause a tight bend and obstruction of the bile duct.

Holetsistoduodenosgomiya (cholecystoduodenostomia) - overlap between anastomosis of the gallbladder and duodenum

The operation is used as a palliative obstruction of the common bile duct due to compression of the major duodenal papilla cancer, or scars, in order to create an outflow of bile. Imposition of fistula between the gallbladder and the duodenum produced by the general rules of technology in the side-by-side anastomosis between the two hollow bodies, similar enteroentero or gastroenterostomy. First, much distended bladder is emptied by puncture, and then the wall it is combined with silk nodal sero-muscular sutures over 3 cm from the front wall of the duodenum, the cavity is opened and the two bodies on the edges of the holes impose a continuous catgut suture through all layers, and finally again silk sero- muscle joints.

At present, the join operation is bile and intrahepatic ducts with the departments of the alimentary canal, the so-called biliodigestive anastomoses were widely as reconstructive surgery. For example, in addition choledochoduodenostomy produce holetsistsrogastrostomiyu, hepaticojejunostomy (hepatic duct connection with the jejunum), making anastomoses between the intrahepatic ducts and the stomach and DR-

Seam liver

Indications. The opening and closing of liver damage, the final stage of liver resection. Seam liver injury belongs to the category of urgent interventions.

Pain relief. Anesthesia.

The surgical procedure. The abdomen is opened upper midline incision with the addition (if necessary) of the cross, passing a few inches above the navel through the abdominal muscles to the right costal arch (T-shaped cross-section). This incision provides access not only to the liver, but also to other organs in the case of detection of damage (stomach, intestinal loops, etc.). With confidence in the isolated liver damage can apply the cut Fedorov, Rio Branco, etc.

If liver injury has smooth edges, limited to the removal of blood clots and the imposition of a number of catgut sutures with large atraumatic needle. Seam start on one side of the wound, departing from the edge of 1.5-2 cm, spend it under the bottom of the wound and gouged out on the other side, too, at a distance of 1.5-2 cm from the edge. After all the seams of their tie. To avoid cutting the joints, they just tighten up the contact surfaces. For large wounds, accompanied by significant bleeding, you should resort to plastic seal; piece clipped or taken on the stem seal put between the wound surface and then sutured as described above. Gland in wounds of the liver is a good gemostatiche-sky means and at the same time promotes rapid healing of wounds. Seam liver Kuznetsov and impose a stump to stop the bleeding.

The edges of the wound stitched double catgut thread with atraumatic needle through the entire thickness from the upper to the lower surface of the liver, with a continuous suture. Then, at the point where the filaments pass, but the upper or lower surface of one of the two strands are cut and bonded to the same manner a cut thread previous puncture tightening and squeezing the entire thickness of the portion located therebetween.

Holetsistoduodenosgomiya (cholecystoduodenostomia) - overlap between anastomosis of the gallbladder and duodenum

The operation is used as a palliative obstruction of the common bile duct due to compression of the major duodenal papilla cancer, or scars, in order to create an outflow of bile. Imposition of fistula between the gallbladder and the duodenum produced by the general rules of technology in the side-by-side anastomosis between the two hollow bodies, similar enteroentero or gastroenterostomy. First, much distended bladder is emptied by puncture, and then the wall it is combined with silk nodal sero-muscular sutures over 3 cm from the front wall of the duodenum, the cavity is opened and the two bodies on the edges of the holes impose a continuous catgut suture through all layers, and finally again silk sero- muscle joints.

At present, the join operation is bile and intrahepatic ducts with the departments of the alimentary canal, the so-called biliodigestive anastomoses were widely as reconstructive surgery. For example, in addition choledochoduodenostomy produce

holetsistsrogastrostomiyu, hepaticojejunostomy (hepatic duct connection with the jejunum), making anastomoses between the intrahepatic ducts and the stomach and DR-

Seam liver

Indications. The opening and closing of liver damage, the final stage of liver resection. Seam liver injury belongs to the category of urgent interventions.

Pain relief. Anesthesia.

The surgical procedure. The abdomen is opened upper midline incision with the addition (if necessary) of the cross, passing a few inches above the navel through the abdominal muscles to the right costal arch (T-shaped cross-section). This incision provides access not only to the liver, but also to other organs in the case of detection of damage (stomach, intestinal loops, etc.). With confidence in the isolated liver damage can apply the cut Fedorov, Rio Branco, etc.

If liver injury has smooth edges, limited to the removal of blood clots and the imposition of a number of catgut sutures with large atraumatic needle. Seam start on one side of the wound, departing from the edge of 1.5-2 cm, spend it under the bottom of the wound and gouged out on the other side, too, at a distance of 1.5-2 cm from the edge. After all the seams of their tie. To avoid cutting the joints, they just tighten up the contact surfaces. For large wounds, accompanied by significant bleeding, you should resort to plastic seal; piece clipped or taken on the stem seal put between the wound surface and then sutured as described above. Gland in wounds of the liver is a good gemostatiche-sky means and at the same time promotes rapid healing of wounds. Seam liver Kuznetsov and impose a stump to stop the bleeding.

The edges of the wound stitched double catgut thread with atraumatic needle through the entire thickness from the upper to the lower surface of the liver, with a continuous suture. Then, at the point where the filaments pass, but the upper or lower surface of one of the two strands are cut and bonded to the same manner a cut thread previous puncture tightening and squeezing the entire thickness of the portion located therebetween. With closed injuries involving fractures of the liver, should be performed: 1) the removal of blood clots and free-lying pieces of liver tissue, and 2) a partial sparing excision of non-viable areas of the liver. Wound surface wrap a piece of omentum, then pull together the wound nodal catgut sutures, carried out through a cloth seal, which gives greater stability against the possible cutting of seams. In liver injury between the seams introduced drainage rubber tube, wrapped a layer of gauze to evacuate accumulates bile and blood. Drainage is not withdrawn in the surgical wound, and through a special hole made under the edge of the costal arch on the axillary line. Before suturing the abdominal cavity must be thoroughly cleaned of blood and bile.

Transactions in pancreas

Surgery for acute pancreatitis. The operation in this disease is the outcrop of the pancreas by dissection of the peritoneum with fascial capsule gland and the tabulation of tampons. The patient on the back.

Pain relief. Local anesthesia or general anesthesia.

The surgical procedure. The abdomen is opened upper midline incision. Dissect the lig. gastrocolicum and penetrate into the packing bag on the back wall of which is iron. Cut along the length of the cut through the peritoneum and prostate gland capsule together with a surface layer of matter gland, in the presence of necrotic areas glands produce removal of blunt. To sum up the section cancer gauze pads. Output end of the tampon through the upper corner of the abdominal wounds. On the other extent the abdominal wound was closed in layers.

Access to the pancreas through the lig. gastrocolicum is advantageous in that the lower floor of the abdomen will be isolated poperechnoobodochnaya bowel mesentery of the top, where the infected focus.

Operation at high pancreatic abscess. To isolate the abscess cavity from the abdominal area stitching produce abscess capsule to the edges of the skin incision over about 6 cm, the rest of the abdominal wound is closed in layers. At the end of 2-3 days abscess is opened through the wall of the filed it and drain the cavity of the conventional method.

Resection. Radical surgery for cancer of the pancreatic head and the major duodenal papilla - pancreatoduodenal resection - is very complex and is still in the development stage. However, different versions of it have been successfully used. The operation consists in the fact that the right side of the pancreas and duodenum were dissected whole, between the stomach and the jejunum anastomosis was created. The surface of the cross section of the rest of the left side of the pancreas and its duct and common bile duct stump is implanted into the lumen of the jejunum.

Surgery for cysts of the pancreas. How parasitic (Echinococcus) and non-parasitic (traumatic) cyst of the pancreas may be the absence of adhesions with the surrounding organs excised. In the presence of adhesions can be applied marsupializatstsya and internal drainage. Marsupialization (sumkovanie) consists in that, after its exposure cyst wall sutured to the edge incision is opened and, after emptying the contents of the cyst lubricated with 10% formalin and its sewn drain tube. Subsequently, the cyst gradually closed or closed surgically. Another way - internal drainage - with non-parasitic cysts is the anastomosis between the cyst cavity and a loop of jejunum.

Splenectomy (splenectomy). Splenectomy

Indications. Indoor and outdoor damage to the spleen, splenomegaly, splenogenny cirrhosis of the liver, cysts (echinococcal).

Position of the patient on his back with inserted under the lower part of the chest roller.

Pain relief. Anesthesia.

The surgical procedure. Accesses: 1) oblique incision parallel to the left costal margin; 2) when a large amount sedezenki and extensive adhesions - thoracicoabdominal access while opening the abdominal and thoracic cavities.

If laparotomy was done on the upper midline incision over the closed trauma to the bodies of unknown localization, then you can access a damaged spleen to the longitudinal cut is added to the cross-section of the left costal arch (T-shaped), like the cut applied to the right to break the liver. The main reception is in the ligation of vessels going to the gastro-splenic ligament.

After opening the abdominal peritoneal curvature of the stomach is pulled right angle splenic colon - down and outputting the wound spleen. If, as is often the case with pathologically altered organ (eg, splenomegaly), the spleen is connected to the diaphragm and other organs of dense adhesions, their pre-cut through between two superimposed vascular clamps Billroth.

When the spleen is freed from adhesions, as well as from the splenic-diaphragmatic ligament, proceed to ligation of blood vessels and simultaneous dissection of the gastro-splenic ligament. For this purpose between the digestive and gastro-splenic ligament, holes, and covering it over his left hand leg of the spleen, bluntly isolated in her splenic artery and vein. To reduce the blood supply body artery ligated at first, and then the vein. On each vessel impose two silk ligatures. Given that from the splenic artery in the gastro-splenic conjunction depart short branches to the bottom of the stomach, the ligature is applied not to the trunk cross, and on the branches as close as possible to the gate, it also eliminates the risk of damage to the tail of the pancreas. Since the splenic artery is very fragile, manipulation on it should be done very carefully, do not use the clips and push the fabric stupid. After the ligation of vessels, separation of adhesions and removal of the spleen produce a thorough check of hemostasis (especially in the dome of the diaphragm) and the abdomen was sutured tightly. Currently, if damaged only one of the poles instead of the spleen splenectomy successfully apply tamponade wound gasket and overlaying it catgut sutures.

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