Workshop 19 Visceral surgery
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Workshop 19 Visceral surgery.
! What are the most typical approaches for surgical intervention on the liver, gall bladder and bile ducts? Kocher’s and Fedorov’s #Rio-Branco and Czerny’s Melnikov’s and Volkmann-Israel’s Kehr’s and Bevin ! What is the way to perform Kocher’s cutting? beginning with the medial line and 3-4 cm lower and parallel to the costal arch; the length is 15-20 cm #along the medial line from the xiphoid process to the bottom without two finger approaching the umbilicus, then turning right and upward till the end of X rib beginning from the xiphoid process along the medial line to the bottom 3-4 cm long and then parallel to the right costal arch transrectal cutting 15-20 cm long ! What is the way to perform Fedorov’s cutting? beginning from the xiphoid process and along the medial line to the bottom 3-4 cm long, and then going parallel to the right costal arch 15-20 cm long #along the medial line from the xiphoid process to the bottom and without two finger approaching the umbilicus and then turning right and upward to the end of X rib beginning from the medial line 3-4 cm lower and parallel to the costal arch, 15-20 cm long pararectal cutting 15-20 cm long ! What is the job of a surgeon when the diagnosis of traumatic break of the liver has been made? hepatic suture and tamponade with omentum #interrupted suture on the liver uninterrupted blanket suture and tamponade with omentum tamponade with omentum ! What must be done by the surgeon at considerable damage of the liver? resection of a hepatic lobe #hepatic suture and tamponade with omentum interrupted suture on the liver biological tamponade of a damaged part of the liver ! What is the way to perform Kuznetsov-Pensky suture? A liver is sutured through the total thickness by a thick dull needle with double catgut thread that is moved up and down the surface of the liver. Then the loop is cut and the ends of the threads are bound in turn. #The liver is sutured by separate double threads. After that the ends of the threads are bound on the superior and inferior surfaces of the liver the liver is sutured by chain-like suture that is composed of separate mattress sutures which threads are tightened parenchyma of the liver is sutured by a long catgut thread like a mattress suture, at first in one direction and then in the opposite one ! What is the way to perform the drainage of extrapleural hepatic abscess according to the method of Melnikov? the skin is cut two-three fingers upper and parallel to the costal arch, 12-15 cm long # the skin is cut beginning from the xiphoidal process at first along the medial line to the bottom 3-4 cm long and then parallel to the costal arch 15-20 cm long the skin is cut from the medial line 3-4 cm lower and parallel to the costal arch; the length is 15-20 cm pararectal cutting 12-15 cm long ! What is the next stage after the incision of the skin and muscles to open the extrapleural hepatic abscess according to the method of Melnikov? subperiosteal resection of two ribs and opening of the pleural sinus, the pleura is exfoliated from the diaphragm and is cut along the passage of the operational wound, its superior margin is sutured to thorax muscles by a layer of loop sutures #the abscess cavity is opened, the pus is removed and the cavity is drained by a rubbed tube or gauze napkins the liver is punctuated by a thick needle or trocar in the most sclerotic area in the center of which fluctuation is observed subperiosteal resection of two ribs and opening of the pleural sinus ! Which of the following approaches are used to revise pancreas? through gastrocolic ligament, through the lesser omentum, through nonvascular zone of transverse colon mesentery # through the left gastropancreatic ligament, pancreosplenic ligament, gastrocolic ligament through gastrocolic ligament, non-vascular zone of transverse colon mesentery, gastrolienal ligament through omentum minus, through non-vascular zone of mesocolon, through the non-vascular zone of transverse colon mesentery, gastrocolic ligament ! What is the most suitable way to revise posterior wall of duodenum and the head of pancreas? by cutting peritoneum along the lateral margin of descending part of duodenum #by cutting gastrocolic ligament through the foramen epiploicum opening of duodenum ! What is the way to mobilize duodenum according to Kocher’s method? parietal peritoneum is dissected along the hepatic flexion of the large intestine, along the descending duodenal part, extraperitoneal cellular tissue is separated and duodenum together with pancreatic head are led to the left #ligament of Treitz is dissected and parietal peritoneum along the horizontal and ascending parts of duodenum and intestine are separated from extraperitoneal cellular tissue parietal peritoneum located to the right from descending duodenal part is dissected, ligament of Treitz is dissected too, and the intestine is separated from extraperitoneal cellular tissue parietal peritoneum located to the right from descending duodenal part is dissected, ligament of Treitz is dissected too, parietal peritoneum is dissected along pars horisontalis and the intestine is separated ! How can the appearance of ascitis in case of cancerous head of pancreas be explained from the topographic anatomic point of view? compression of v. porta #compression of inferior v. cava pancreatic duct obstruction obstruction of pancreatic part of the common bile duct ! During the operation it was necessary to find the place of formation of v. porta. Where is it identified? behind the head of pancreas #behind the body of pancreas in hepatic duodenal ligament behind duodenum ! What is the most effective way to get to the pancreas? cutting of gastrocolic ligament # cutting of hepatogastric ligament cutting of pancreosplenic ligament entering the finger into the Winslow foramen ! What part of duodenum does ductus choledochus enter? pars descendens #pars superior pars ascendens pars inferior ! What part of the common bile duct is located in ligamentum hepatoduodenale? pars supraduodenalis #pars intramuralis pars retroduodenalis pars retropancreatica ! What are the reasons to perform cholecystectomy? calculous cholecystitis #gastroduodenitis dyskinesia of extrahepatic bile ducts chronic gastritis ! What method of cholecystectomy allows decreasing the appearance of stones in the common bile duct from the gall bladder during the operation? from the neck #from the bottom the method itself is of no importance from the body ! In what cases is “from the bottom” cholecystectomy performed? marked adhesive process #at chronic cases at calculous cholycystitis at periprocesses ! Why is it necessary to peritonize a gallbladder after its removal? to prevent bile and blood from running into the gallbladder after its removal #to avoid the appearance of commissures to avoid the formation of stones to prevent the development of purulent and septic complications ! During the operation “from the neck” it was necessary to identify the topography of a common bile duct. The union of what ducts is it composed of? common hepatic and cystic duct #left hepatic and cystic duct common hepatic and right hepatic ducts left and right hepatic ducts ! During the operation “from the neck” a surgeon identifies the artery of the gallbladder. What artery does a. cystica branch off? a. hepatica dextra #a. hepatica propria a. hepatica sinistra a. mesenterica superior ! Name the stages of cholecystectomy: lig. Hepatoduodenale is cut, cystic duct and common bile duct are opened, bound and crossed with a. cystica and gallbladder duct in Kalo triangle, the gallbladder is removed subserously and its bed is peritonized #the gallbladder is removed subserously, lig. Hepatoduodenale is cut, the gallbladder duct and common bile duct are opened and bound to a. cystica in Kalo triangle, the bed of the gallbladder is peritonized lig. Hepatoduodenale is cut, binded and transected a. cystica and ductus choledochus are bound and crossed in Kalo triangle lig. Hepatoduodenale is cut, перев`язують a. cystica and ductus hepaticus communis are bound and crossed in Kalo triangle ! Name the stages of cholecystomy: The bottom of the gallbladder is performed with a purse-string suture, it is then punctuated, cut and the content is removed, the gallbladder cavity is drained and fixed with a purse-string suture, the wall of the gallbladder is sutured to the peritoneum #lig. Hepatoduodenale is cut, a. cystica and ductus cysticus are bound and crossed in the Kalo triangle the wall of the gallbladder is sutured to the anterior wall of duodenum, on the distance of 0,5 from sutures’ line the lumens of the organs are opened and anastomosis is performed lig. Hepatoduodenale is cut, on the supraduodeno-jejunale part of the duct the suture holder is put and between them the duct is cut in longitudinal direction, after removing the concrements the common bile duct is drained !:Name the stages of transduodenal papilosfincteroplasty: duodenum is mobilized, duodenotomy is performed, the sphincter is cut by sonde and the calculus is removed, mucosa of ductus choledochus and duodenal opening are sutured #lig. hepatoduodenale is cut and common bile duct is opened by longitudinal direction, duodenum is cut by transversal cutting and anastomosis is performed duodenotomy is performed, the sphincter is cut by sonde in the direction of 10-11 hours, duodenal opening is sutured by two-row suture the bottom of the gallbladder is performed with purse-string suture, it is cut, the cavity is drained and fixed with purse-string suture ! Name the stages of choledochoduodenostomy according to the method of Yurash-Vinogradov: lig. Hepatoduodenale is cut and common bile duct is opened, supraduodenal part of the duct is cut in longitudal direction, transversal cutting of duodenum and anastomosis is performed #lig. Hepatoduodenale is cut, on the supraduodenal part of the duct the suture holder is put and between them the duct is cut in longitudinal direction, concrements are removed, the duct is drained the wall of the gallbladder is sutured to the anterior wall of duodenum, on the distance of 0,5 from sutures’ line the lumens of both organs are opened and anastomosis is performed duodenotomy is performed, the sphincter is cut by sonde, after the removal of concrements duodenal opening is sutured by the two-row suture !:Name the stages of cholecystoduodenostomia: the wall of the gallbladder is sutured to the anterior wall of duodenum, on the distance of 0,5 cm from the sutures the lumens of both organs are opened and anostomosis is performed #lig. Hepatoduodenale is cut and common bile duct is opened by longitudal cutting, duodenum is cut transversally and anostomosis is performed the bottom of the gallbladder is performed with a purse-string suture, the bottom in the center of the suture is cut, the stones are removed, a rubbed tube is enetered fixed by a purse-string suture mobilization of duodenum, duodenotomy, cutting of the sphincter, removal of the stone, the mucosa of choledochus and duodenum is sutured, duodenal opening is sutured ! What is the way to open the abdominal cavity at splenectomia? By oblique or angular cutting along the left costal arch #transrectal or pararectal cutting, 15-20 cm long supramedian laparotomy middlemedian laparotomy ! What ligament is incised by the surgeon to get to the vessels of the spleen? gastrolienal ligament # splenophrenic ligament gastrophrenic ligament gastrocolic ligament ! What is the procedure to ligature the elements of vascular pedicle of the spleen at its removal? at first on the artery, then on the vein #at first on the vein, then on the artery simultaneously on the artery and vein on the artery |
