General Surgery Notes

Surface Anatomy of The Abdomen
Incisions
Hernias
Anatomy of Suprapubic and Inguinal Region
Surgical Procedures: Hernias

• Open Repair of Indirect Inguinal Hernia (Herniorrhaphy)

• Laproscopic Direct Hernia Repair
  • Transobdominal Preperitoneal (TAPP)
  • Transobdominal Extraperitoneal (TEP)

• Open Repair of Femoral Hernia

• Incisional or Ventral Hernia Repair

• Umbilical Hernia Repair

• Spigelian Hernia Repair
  • Spigelian: uncommon
  • Diagnosis: difficult - CT, Ultrasonic scanning
    • Confirmed by exploratory laparotomy
      • Symptoms: intestinal obstruction
  • Function: reduce a protrusion of a peritoneal sac, perotoneal fat or other abdominal vicera
  • Cause: congenital or acquired defect of the muscle wall - spigelian zone
  • Steps:
    • Skin incision made
    • Hernia sac is identified
    • Sac are examined for ischemia, sac is resected and contents are reduced into the peritoneal cavity
    • Defect is repaired (strangulated hernias)
    • Marlex/Gore-Tex required for larger defects

thats just a taste of surgery, ill try to keep chipping away

Terminology

• Abdominal peritoneum: serous membrane lining the walls of the abdominal cavity
• Adipose tissue: layer of tissue containing fat cells
• Epigastric: region of the abdomen above the umbilicus, following the upper edge of the stomach
• Fascia: a fibrous band or membrane lying deep to the skin and supporting muscles
• Hypogastric: below the level of the stomach
• Linea alba: a tendinous medial line on the anterior abdominal wall; separates the rectus muscles
• McBurney incision: an oblique RIGHT muscle splitting incision used for exploration and removal of the appendix
  • He gets a name!? no fair... :<
• Muscle splitting incisions: incision that separates muscle tissues along the length of their fibers. THe msucle is not cut. This results in little or no bleeding and prevents the moderate to severe postoperative pain associated with muscle cutting
• Paramedian: an incision of the vertical abdominal wall lateral to the midline
• Pfannelsteil: a transverse incision of the lower abdoment below the umbilicus and just above the pubis in a natrual crase or fold
• Subcostal: under the rib, incision or area of the abdominal wall that follows the oblique slopw of the tenth costal cartilage
• Subcutaneous tissue: the superficial fascia layer that covers the abdominal wall, fatty tissue that attaches to this tissue can range form several ml to inches thick
• Transverse incision: an incision that folows a line perpendicular to the midline of the body
• Spigelain Zone: area of aponeurosis that lies between the linea semilunaris of the transverse abdominis msucle and the lateral edge of the rectus muscle