Jeffrey Eric Criste

 Removal by surgery of the appendix, the

small worm-like appendage of the colon
(the large bowel). An appendectomy is
performed because of probable appendicitis
, inflammation of the wall of the appendix
generally associated with infection.
 Appendicitis usually is suspected because
of the medical history and physical
examination. The pain of developing
appendicitis is at first diffuse and poorly
localized (not confined to one spot) but, as
the inflammation extends through the
appendix to its outer covering and then to
the lining of the abdomen, the pain changes
and becomes localized to one small area
between the front of the right hip bone and
the belly button. The exact point is named
after Dr. Charles McBurney - McBurney's
point. If the appendix ruptures and infection
spreads throughout the abdomen, the pain
becomes diffuse again as the entire lining
of the abdomen becomes inflamed.
Ultrasonography and computerized
tomography also may be helpful in
diagnosis.
 Due to the varying size and location of the
appendix and the proximity of other organs
to the appendix, it may be difficult to
differentiate appendicitis from other intra-
abdominal diseases.
 The treatment for appendicitis is antibiotics
and surgical removal of the appendix
  Is the surgical removal of the gallbladder.
Despite the development of non-surgical
techniques, it is the most common method
for treating symptomatic gallstones,
although there are other reasons for having
this surgery done. Each year more than
500,000 Americans have gallbladder
surgery. Surgery options include the
standard procedure, called laparoscopic
cholecystectomy, and an older more
invasive procedure, called open
cholecystectomy. A cholecystectomy is
performed when attempts to treat gallstones
with ultrasound to shatter the stones or
medications to dissolve them have not
proved feasible.
 One common complication of
Cholecystectomy is an anomaly known as
Ducts of Luschka, occurring in 33% of the
population, is non-problematic until the gall
bladder is removed, and the tiny
supravesicular ducts may be incompletely
cauterized or remain unobserved, leading to
biliary leak post operatively. The patient will
develop biliary peritonitis within 5 to 7 days
following surgery, and will require a
temporary biliary stent. It is important that
the clinician recognize the possibility of bile
peritonitis early and confirm diagnosis via
HIDA scan to lower morbidity rate.
Aggressive pain management and antibiotic
therapy should be initiated as soon as
 Large bowel resection is surgery to
remove part of your large bowel.
The large bowel connects the small
intestine to the anus. It is also
called the large intestine or colon.
 Alternative Names: Large
intestine surgery; Colon resection;
Resection of part of large intestine;
Colectomy; Proctocolectomy
 Description:
 In most cases, your bowel is
cleaned before the surgery with
enemas and medication.
 The surgery is performed while you
are under general anesthesia. This
means you are unconscious and
pain-free. A cut is made in your
abdomen. The diseased part of the
large bowel is removed and the
two healthy ends of the bowel are
sewn back together (resected).
The cut is closed. If the entire
colon and rectum is removed, it is
called a proctocolectomy.
 A bowel resection may be performed as
a traditional "open" procedure or as a
minimally invasive
laparoscopic procedure .
 Indications:
 Large bowel resection is used to treat a
variety of conditions, including:
 Colon cancer
 Diverticular disease
 A block in the intestine due to scar
tissue
 Convalescence:
 Most patients will stay in the hospital
for 5 to 7 days. Complete recovery from
surgery may take 2 months. During the
first few days after surgery, eating is
restricted.
 Laparoscopic bowel resection for colon
cancer may result in a faster recovery
time than traditional open surgery.
A colostomy is an incision (cut) into the
colon (large intestine) to create an artificial
opening or "stoma" to the exterior of the
abdomen. This opening serves as a
substitute anus through which the
intestines can eliminate waste products
until the colon can heal or other corrective
surgery can be done. The bowel
movements fall into a collection pouch.
Our ostomy nursing staff will teach you
skin care and how to change the bag.
 When is a colostomy needed?
 A colostomy may be needed to divert intestinal contents in
conditions such as necrotizing enterocolitis ( an acute
inflammatory disease of the bowel), imperforate anus
(absence of anal opening) or Hirschsprung's Disease (a
condition in which the nerves controlling bowel function are
abnormal). Each one of these conditions will be explained in
detail by your pediatric surgeon.
 How is a colostomy created?
 an abdominal opening is created
 the intestines are brought out through the skin
 the intestine is sutured to the skin
 Gastrectomy is the surgical removal of all or part of the
stomach.
 Purpose
 Gastrectomy is performed for several reasons, most commonly
to remove a malignant tumor or to cure a perforated or
bleeding stomach ulcer.
 Description
 Gastrectomy for cancer
 Removal of the tumor, often with removal of surrounding
lymph nodes, is the only curative treatment for various forms
of gastric (stomach) cancer. For many patients, this entails
removing not just the tumor but part of the stomach as well.
The extent to which lymph nodes should also be removed is a
subject of some debate, but some studies show additional
survival benefit associated with removal of a greater number
of lymph nodes.
 Gastrectomy, either total or subtotal (also called partial), is
the treatment of choice for gastric adenocarcinomas, primary
gastric lymphomas (originating in the stomach), and the rare
leiomyosarcomas (also called gastric sarcomas).
Adenocarcinomas are by far the most common form of
stomach cancer and are less curable than the relatively
uncommon lymphomas, for which gastrectomy offers good
 After gastrectomy, the surgeon may "reconstruct" the
altered portions of the digestive tract so that it continues to
function. Several different surgical techniques are used, but,
generally speaking, the surgeon attaches any remaining
portion of the stomach to the small intestine.
Gastrectomy for gastric cancer is almost always done by the
traditional "open" surgery technique, which requires a wide
incision to open the abdomen. However, some surgeons use
a laparoscopic technique that requires only a small incision.
The laparoscope is connected to a tiny video camera that
projects a picture of the abdominal contents onto a monitor
for the surgeon's viewing. The stomach is operated on
through this incision.
The potential benefits of laparoscopic surgery include less
postoperative pain, decreased hospitalization, and earlier
return to normal activities. The use of laparoscopic
gastrectomy is limited, however. Only patients with early
stage gastric cancers or those whose surgery is only
intended for palliation-pain and symptomatic relief rather
than cure-should be considered for this minimally invasive
technique. It can only be performed by surgeons
 This procedure involves dissecting the gall
bladder off of the liver, making a hole in the gall
bladder and sewing it to a hole made in the small
intestine
 This allows bile to flow from the liver to gall
bladder, then directly to the intestine - this is in
essence a by-pass for bile so that it no longer
needs to flow through the common bile duct
 Indications for cholecystoduodenostomy
 scarred or constricted common bile duct which
does not allow bile to pass through to the
intestine
 tumor of the common bile duct
 pancreatitis which causes the common bile duct
to swell shut
 A colectomy is surgery to remove all or part of the
colon, which is the large intestine, measuring  about 5
feet (150 centimeters) long. The colon stores and
mobilizes waste until it is eliminated from the body. It
extends from the small intestine to the rectum, which
is the lower 6 inches (15 centimeters) or so of the
large intestine. A hemicolectomy (removal of about
one-half of the colon) is the primary treatment for
colorectal cancer. The amount of colon removed during
the procedure depends on how extensive the cancer
has penetrated the wall of the bowel. It also depends
on whether or not the cancer has metastasized
(spread) to the lymph nodes or other areas of the
body.
 Most people have a good outcome following a colectomy.
Statistics reveal no recurrence of cancer in more than 80
percent of early-stage patients more than four years after
surgery, according to the American Academy of Family
Physicians.
 The types of colectomies include:
 Total colectomy. The entire colon is removed.
 Right hemicolectomy. Right part of the colon is removed.
This procedure is called ileocolectomy when the lower small
intestine is removed as well.
 Left hemicolectomy. Left portion of the colon is removed.
 Segmental resections or partial colectomies. Smaller colon
segments are removed.
 During a colectomy, the surgeon removes the part of the colon that
contains the cancer. A portion (margin) of surrounding normal
tissue is also removed to reduce the chances of stray cancer cells
remaining in the body. Nearby lymph nodes may be removed for
biopsy to determine if the cancer has spread.
 The surgeon will then try to reconnect the healthy portions of the
colon or rectum. In some cases, this is not possible because of the
location of the cancer or other factors. In such situations, the
patient may need an operation known as a colostomy. This
procedure temporarily or permanently redirects body waste to an
opening created in the patient’s abdomen where it is drained from
the body into an attached bag.
 Colectomy is also used to treat other medical disorders that may or
may not be related to colorectal cancer. For example, a rare,
inherited syndrome known as familial adenomatous polyposis
(FAP) sometimes requires removal of the entire colon and rectum.
This procedure is known as ileal pouch-anal anastomosis, in which
the surgeon usually constructs a pouch from the end of the small
intestine that attaches directly to the anus. Waste is then expelled
normally, although bowel movements frequently are watery.
 Other conditions that may require a colectomy include:
 Precancerous polyps
 Diverticular disease
 Intestinal blockage due to scar tissue
 Chronic inflammatory bowel disease, such as ulcerative colitis or
Crohn's disease
 Fecal incontinence
 Traumatic injuries
 A lobectomy is the removal of a lobe of one of the
organs, usually referring to the brain, the lung, or
the liver.
 Purpose
 Lobectomies are usually performed to prevent the
spread of cancer from part of one organ to other
parts of the organ or other parts of the body.
Lobectomies are also performed on patients with
severe seizure disorders (such as some forms of
epilepsy) to prevent further seizures. However, there
are differences in each of the three organs on which
lobectomies may be performed.
 The liver has an amazing ability to repair itself. Even
if up to three-quarters of the liver is removed it will
start to re-grow very quickly, and may be back to
normal size within a few weeks.

Sometimes a lobe of the liver may be removed.  This
is called lobectomy. If you have no underlying
medical problems with your liver (such as cirrhosis) it
is possible for the liver to grow back following
surgery and work normally.  It is often possible to
remove fibrolamellar HCC, as this is more likely to
 A splenectomy is a procedure that involves the removal of the spleen by
operative means.
 The spleen, similar in structure to a large lymph node, acts as a blood filter.
Current knowledge of its purpose includes the destruction of old
red blood cells and platelets, and the detection and fight against certain
bacteria. It's also known to create new blood cells. The spleen is enlarged in
a variety of conditions such as malaria, mononucleosis and most commonly
in "cancers" of the lymphatics, such as lymphomas or leukemia.
 It is removed under the following circumstances:
 When it becomes very large such that it becomes destructive to platelets/red
cells
 For diagnosing certain lymphomas
 When platelets are destroyed in the spleen as a result of an auto-immune
process
 When the spleen bleeds following physical trauma
 Following spontaneous rupture
 For long-term treatment of congenital erythropoietic porphyria (CEP) if
severe hemolytic anemia develops.
 The classical cause of traumatic damage to the
spleen is a blow to the abdomen during a sporting
event. In cases where the spleen is enlarged due
to illness (mononucleosis), the smallest things
such as leaning over a counter or straining at
stool can cause it to rupture.
 Procedure
 Vaccination for pneumococcus, H. influenza and
meningococcus should be given pre-operatively if
possible. In general, spleens are removed by
laparoscopy (minimal access surgery) when the
spleen is not too large and when the procedure is
elective. It is performed by open surgery for
trauma or large spleens. Both methods are major
surgeries, and are performed under
general anesthesia. The spleen is located and
disconnected from its arteries. The ligaments
holding the spleen in place are dissected and the
spleen is removed. When indicated a drain is left
in place and the incision(s) is closed. If necessary,
tissue samples are sent to a laboratory for
 A laparotomy is a large incision made into the abdomen.
Exploratory laparotomy is used to visualize and examine
the structures inside of the abdominal cavity.
 Purpose
 Exploratory laparotomy is a method of abdominal
exploration, a diagnostic tool that allows physicians to
examine the abdominal organs. The procedure may be
recommended for a patient who has abdominal pain of
unknown origin or who has sustained an injury to the
abdomen. Injuries may occur as a result of blunt trauma
(e.g., road traffic accident) or penetrating trauma
(e.g., stab or gunshot wound). Because of the nature of
the abdominal organs, there is a high risk of infection if
organs rupture or are perforated. In addition, bleeding
into the abdominal cavity is considered a medical
emergency. Exploratory laparotomy is used to determine
the source of pain or the extent of injury and perform
repairs if needed.
 Laparotomy may be performed to determine the
cause of a patient's symptoms or to establish the
extent of a disease. For example, endometriosis is
a disorder in which cells from the inner lining of
the uterus grow elsewhere in the body, most
commonly on the pelvic and abdominal organs.
Endometrial growths, however, are difficult to
visualize using standard imaging techniques such
as x ray, ultrasound technology, or computed
tomography (CT) scanning. Exploratory
laparotomy may be used to examine the
abdominal and pelvic organs (such as the ovaries,
fallopian tubes, bladder, and rectum) for evidence
of endometriosis. Any growths found may then be
removed.
 Exploratory laparotomy plays an important role in
the staging of certain cancers. Cancer staging is
used to describe how far a cancer has spread. A
laparotomy enables a surgeon to directly examine
the abdominal organs for evidence of cancer and
remove samples of tissue for further examination.
When laparotomy is used for this use, it is called
 Description
 The patient is usually placed under general anesthesia
for the duration of surgery. The advantages to general
anesthesia are that the patient remains unconscious
during the procedure, no pain will be experienced nor
will the patient have any memory of the procedure,
and the patient's muscles remain completely relaxed,
allowing safer surgery.
 Incision
 Once an adequate level of anesthesia has been
reached, the initial incision into the skin may be made.
A scalpel is first used to cut into the superficial layers
of the skin. The incision may be median (vertical down
the patient's midline), paramedian (vertical elsewhere
on the abdomen), transverse (horizontal), T-shaped, or
curved, according to the needs of the surgery. The
incision is then continued through the subcutaneous
fat, the abdominal muscles, and finally, the
peritoneum. Electrocautery is often used to cut
through the subcutaneous tissue as it has the ability to
stop bleeding as it cuts. Instruments called retractors
may be used to hold the incision open once the
abdominal cavity has been exposed.