in any operation - mansosp.mans.edu.eg/tmahdy/students/operative/operative.pdf · incision planning...
TRANSCRIPT
![Page 1: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/1.jpg)
In any operation
•• Indications Indications ..•• AnaesthesiaAnaesthesia ..•• Position of the patient Position of the patient ..•• Incision Incision ..•• Steps of the operation Steps of the operation ..•• Complications Complications ..
![Page 2: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/2.jpg)
Abdominal operation
SupineSupine
I position for operation
![Page 3: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/3.jpg)
Abdominal operation
TrendelenburyTrendelenbury
I position for operation
![Page 4: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/4.jpg)
Abdominal operation
Lateral positionLateral position
I position for operation
![Page 5: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/5.jpg)
Cross section of upper abdomenCross section of upper abdomen
Anatomy of Abdominal wall
![Page 6: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/6.jpg)
Cross section of lower abdomenCross section of lower abdomen
Anatomy of Abdominal wall
![Page 7: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/7.jpg)
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
![Page 8: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/8.jpg)
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
![Page 9: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/9.jpg)
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
![Page 10: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/10.jpg)
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
![Page 11: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/11.jpg)
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
![Page 12: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/12.jpg)
Muscle & tendons of Muscle & tendons of abdominal wall abdominal wall ..
Anatomy of Abdominal wall
![Page 13: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/13.jpg)
Incision Planning
Adequate access Adequate access ..
Minimum damage Minimum damage ..
Strong and durable scar Strong and durable scar ..
LangerLanger’’s line in children s line in children ..
Abdominal incisions
![Page 14: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/14.jpg)
Types of incisions
![Page 15: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/15.jpg)
Midline incision
![Page 16: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/16.jpg)
Midline incision
![Page 17: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/17.jpg)
Repair of complete
burst abdomen
Midline incision
![Page 18: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/18.jpg)
Paramedian incision
![Page 19: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/19.jpg)
Paramedian incision
![Page 20: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/20.jpg)
Paramedian incision
![Page 21: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/21.jpg)
Paramedian incision
![Page 22: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/22.jpg)
Paramedian incision (closure)
![Page 23: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/23.jpg)
Skin Skin ..ExtExt. . oblique oblique apap..IntInt. . oblique moblique m..TransversusTransversus ..FF. . TrTr. + . + peritperit ..
Grid iron incision
![Page 24: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/24.jpg)
Subcostal incision
![Page 25: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/25.jpg)
Transverse upper Abdominal incision
![Page 26: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/26.jpg)
Transverse upper Abdominal incision
![Page 27: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/27.jpg)
Transverse lower Abdominal incision[Pfannenstiel]
![Page 28: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/28.jpg)
Transverse lower Abdominal incision[Pfannenstiel]
![Page 29: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/29.jpg)
Pulmonary Pulmonary ..Cardiovascular Cardiovascular ..
ShockShockHemorrhageHemorrhageDVTDVT
GITGIT..Vomiting Vomiting Abdominal distensionAbdominal distensionHiccoughHiccough
UrinaryUrinaryUraemiaUraemiaRetention of urineRetention of urine
Wound complicationWound complication
Post operation complication
![Page 30: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/30.jpg)
HaematomaHaematoma & & SeromaSeroma ..
Infection Infection ..stitch sinus .Cellulitis .infected hematoma.
Surgical emphysema Surgical emphysema ..
Wound dehiscenceWound dehiscence (complete burst)(partial burst) .
Post operation wound complications
![Page 31: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/31.jpg)
Cholecystectomy
![Page 32: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/32.jpg)
Indications :
Chronic Chronic calcularcalcular cholecystitischolecystitis ..Acute Acute calcularcalcular cholecystitischolecystitis ((within 48 Hwithin 48 H.).)TrumaticTrumatic rupture rupture ..Malignant gall bladder Malignant gall bladder + + wedge of liver wedge of liver ..In hepatic resection In hepatic resection ..SymptomlessSymptomless gall stones in some casesgall stones in some cases
-- Diabetes - Big stones- non functioning gall bladder - calcified (porcalen) G.B.
Cholecystectomy
![Page 33: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/33.jpg)
Ultrasound Ultrasound ..
IVC IVC ..
ERCP ERCP / / PTC PTC ..
Pre operative assessment of C.B.D.
Cholecystectomy
![Page 34: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/34.jpg)
AnaesthesiaAnaesthesia
Position of patientPosition of patient((operative tableoperative table//imageimage))
Incision Incision ::-- SubcostalSubcostal-- RtRt paramedianparamedian
Cholecystectomy
![Page 35: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/35.jpg)
Plain X ray
Radio opaqu
Gall stones
![Page 36: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/36.jpg)
Ultrasound
Show gall stone with posterior shadow
![Page 37: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/37.jpg)
Oral cholecystogram
![Page 38: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/38.jpg)
Plain X ray
Calcified gall bladder
![Page 39: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/39.jpg)
ERCP
Normal bile ducts
![Page 40: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/40.jpg)
ERCP
Multiple
CBD stones
![Page 41: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/41.jpg)
![Page 42: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/42.jpg)
![Page 43: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/43.jpg)
![Page 44: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/44.jpg)
Sites of Towels
![Page 45: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/45.jpg)
![Page 46: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/46.jpg)
![Page 47: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/47.jpg)
![Page 48: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/48.jpg)
![Page 49: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/49.jpg)
![Page 50: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/50.jpg)
![Page 51: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/51.jpg)
![Page 52: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/52.jpg)
![Page 53: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/53.jpg)
![Page 54: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/54.jpg)
![Page 55: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/55.jpg)
![Page 56: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/56.jpg)
![Page 57: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/57.jpg)
![Page 58: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/58.jpg)
![Page 59: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/59.jpg)
![Page 60: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/60.jpg)
![Page 61: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/61.jpg)
![Page 62: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/62.jpg)
Missed CBD stone
T-tube still present
![Page 63: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/63.jpg)
CutaneusExtraction of CBD stone through T. tube track
![Page 64: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/64.jpg)
![Page 65: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/65.jpg)
![Page 66: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/66.jpg)
![Page 67: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/67.jpg)
![Page 68: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/68.jpg)
![Page 69: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/69.jpg)
![Page 70: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/70.jpg)
![Page 71: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/71.jpg)
![Page 72: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/72.jpg)
![Page 73: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/73.jpg)
![Page 74: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/74.jpg)
![Page 75: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/75.jpg)
![Page 76: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/76.jpg)
ComplicationsHaemorrhageHaemorrhageLiver failure due to hepatic ALiver failure due to hepatic A. . ligationligation ..Injury of bile ducts Injury of bile ducts ..
* Jaundice * Biliary peritonitis * Biliary fistula
Post Post cholecystectomycholecystectomy syndromesyndrome* stone missed* stricture CBD* Stump long* Symptoms due to other pathology
Cholecystectomy
![Page 77: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/77.jpg)
![Page 78: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/78.jpg)
![Page 79: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/79.jpg)
![Page 80: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/80.jpg)
![Page 81: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/81.jpg)
Indications :
Acute appendicitis Acute appendicitis ((no massno mass) .) .
Recurrent or chronic AppRecurrent or chronic App. .
Carcinoma of appendix Carcinoma of appendix ..
CarcinoidCarcinoid tumor of appendix tumor of appendix ..
Appendectomy
![Page 82: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/82.jpg)
AnaesthesiaAnaesthesia
Position Position
IncisionIncision-- grid irongrid iron-- RtRt paramedianparamedian-- lanzlanz transverse incisiontransverse incision
Appendectomy
![Page 83: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/83.jpg)
![Page 84: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/84.jpg)
![Page 85: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/85.jpg)
![Page 86: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/86.jpg)
![Page 87: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/87.jpg)
![Page 88: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/88.jpg)
![Page 89: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/89.jpg)
![Page 90: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/90.jpg)
![Page 91: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/91.jpg)
![Page 92: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/92.jpg)
![Page 93: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/93.jpg)
Residual abscess Residual abscess ((pelvic or pelvic or subphrenicsubphrenic) .) .
FaecalFaecal fistula fistula ..
Paralytic Paralytic ileusileus ..
Wound infection Wound infection ..
Wound hernia Wound hernia ..
Post appendectomy complications
![Page 94: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/94.jpg)
SplenectomyIndications :-
Rupture spleen Rupture spleen ..Conditions related to the spleen Conditions related to the spleen . .
- Cysts - Tumor- T.B - Abscess
SplenicSplenic artery aneurysm artery aneurysm ..With total With total gastrectomygastrectomy for cancer stomach for cancer stomach ..SplenomegalySplenomegaly with blood diseases with blood diseases ..
- cong. Spherocytosis- Haemolytic anemia (auto immune)- Hyper splenism- malarial spleen (Tropical)
In relation to portal hypertensionIn relation to portal hypertension- Hassab - Proximal spleno-renal shunt
![Page 95: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/95.jpg)
![Page 96: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/96.jpg)
![Page 97: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/97.jpg)
![Page 98: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/98.jpg)
![Page 99: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/99.jpg)
![Page 100: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/100.jpg)
![Page 101: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/101.jpg)
![Page 102: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/102.jpg)
![Page 103: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/103.jpg)
![Page 104: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/104.jpg)
![Page 105: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/105.jpg)
![Page 106: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/106.jpg)
End – side porta – caval anastmosis
![Page 107: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/107.jpg)
End – side cavo – mesenteric anastmosis
![Page 108: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/108.jpg)
H – graft Mesent. – caval anastmosis
![Page 109: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/109.jpg)
Central spleno-renal anastmosis
![Page 110: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/110.jpg)
Distal spleno-renal anastmosis(Warren shunt)
![Page 111: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/111.jpg)
Haemorrage .Pancreatic injury .Gastric injury gastric fistula .Colonic injury colonic fistula .Left subphrenic collection & abscess .D. V. T.Burst abdomen due to wound sepsis .Infection specially in children .
Post splenectomy complications
![Page 112: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/112.jpg)
NephrectomyIndications :-
Patient having transplant & his own kidney is infected or causing renal hypertension.Non functioning kidney (the other is normal) in association with :-
Hydronephrosis - Byonephrosisstones - ischemia
Trauma (inevitable)T.B. (resistant treatment)Tumors :
renal cell T. RadicalTr. Cell T. Nephro-uretrectomy
Unilateral renal hypertension if failed renal A. reconstruction .
![Page 113: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/113.jpg)
NephrectomyAnaesthesiaAnaesthesia
Position Position
Incision Incision ::- Lumbar- Bed of 12th rib.- Anterior approach.
![Page 114: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/114.jpg)
NephrectomyIn renal carcinoma :
More radical More radical kidney kidney + + perinephricperinephric fat fat + + supra renal Gsupra renal G..
LigationLigation of renal vein early of renal vein early ..
In In RtRt. . Side Side ((the vein is shortthe vein is short) ) open open IVIV..CC. . to remove tumor emboli to remove tumor emboli ..
![Page 115: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/115.jpg)
![Page 116: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/116.jpg)
![Page 117: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/117.jpg)
![Page 118: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/118.jpg)
![Page 119: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/119.jpg)
![Page 120: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/120.jpg)
![Page 121: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/121.jpg)
![Page 122: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/122.jpg)
![Page 123: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/123.jpg)
![Page 124: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/124.jpg)
![Page 125: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/125.jpg)
![Page 126: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/126.jpg)
![Page 127: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/127.jpg)
![Page 128: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/128.jpg)
![Page 129: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/129.jpg)
ThyoridectomyIndications :-
Simple diffuse goitre + pressure .S. N. G. to avoid complications .Solitary Nodule .1 ry toxic goitre after medications .2 ry toxic goitre after medications .Malignant goitre .
![Page 130: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/130.jpg)
Subtotal :-Bilateral removal leaving small parts .
Hemi thyroidectomy :-(Lobectomy) = entire lobe + isthmus .
Total thyoidectomy :-Rilat. Lobectomy + implantation of
parathyroid .Excision of isthmus
to relief pressure on trachea .
Types of Thyoridectomy
![Page 131: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/131.jpg)
ThyroidectomyPosition Position
IncisionIncision
StepsSteps
![Page 132: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/132.jpg)
![Page 133: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/133.jpg)
![Page 134: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/134.jpg)
![Page 135: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/135.jpg)
![Page 136: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/136.jpg)
![Page 137: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/137.jpg)
![Page 138: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/138.jpg)
![Page 139: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/139.jpg)
![Page 140: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/140.jpg)
![Page 141: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/141.jpg)
![Page 142: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/142.jpg)
![Page 143: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/143.jpg)
![Page 144: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/144.jpg)
![Page 145: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/145.jpg)
![Page 146: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/146.jpg)
![Page 147: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/147.jpg)
![Page 148: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/148.jpg)
![Page 149: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/149.jpg)
Thyoridectomy
Complications
Thyroid crises .Haemorrhage .Respiratory obstruction due to oedema.Rec. L. nerve injury .Hypothyroidism .Hypoparathyroidism .Recurrent toxicosis
![Page 150: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/150.jpg)
Inguinal Hernia Repair
![Page 151: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/151.jpg)
![Page 152: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/152.jpg)
![Page 153: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/153.jpg)
![Page 154: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/154.jpg)
![Page 155: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/155.jpg)
![Page 156: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/156.jpg)
![Page 157: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/157.jpg)
![Page 158: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/158.jpg)
![Page 159: In any operation - Mansosp.mans.edu.eg/tmahdy/students/operative/Operative.pdf · Incision Planning Adequate access . Minimum damage . Strong and durable scar . Langer’s line in](https://reader036.vdocuments.mx/reader036/viewer/2022070714/5ed55673cfcb033b55255b48/html5/thumbnails/159.jpg)