Module 14: GI Surgery Techniques

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Questions and Answers

What is the primary purpose of using bowel/isolation technique during surgery?

To prevent cross-contamination with bowel organisms (correct)

To facilitate faster closure of the wound

To enhance the healing process of the incision

To reduce the amount of anesthesia needed

When does the bowel technique begin during a surgical procedure?

Once the patient is anesthetized

Before any instruments are used

As soon as the GI tract is clamped and opened (correct)

Immediately after the incision is made in the skin

What type of stapling device is used for side-to-side anastomoses?

TA Stapler

GIA Stapler (correct)

Manual Stapler

Endoscopic GIA Stapler

What is a characteristic feature of the TA stapler?

It requires manual cutting Signup and view all the answers

What additional measure is taken during bowel technique after completing the anastomosis?

The surgical team changes gloves and gowns if necessary Signup and view all the answers

What is the function of the GIA stapler in surgical procedures?

To create side-to-side anastomoses Signup and view all the answers

In which scenario is the GIA stapler's no-knife version utilized?

In endoscopic versions for gynecological surgeries Signup and view all the answers

What is a potential consequence of not using bowel/isolation technique during the surgery?

Increased chance of mechanical metastasis Signup and view all the answers

What is the primary function of the GIA stapler in gastrointestinal procedures?

To create side-to-side anastomosis Signup and view all the answers

Why is it important to ensure the blood supply of the superior and inferior mesenteric arteries is intact during bowel surgery?

To maintain bowel viability Signup and view all the answers

What type of suture is recommended for the repair of the internal serosa?

Absorbable vicryl suture Signup and view all the answers

What is the purpose of the dilator used in the open Nissen Fundoplication procedure?

To prevent suturing the esophagus shut Signup and view all the answers

What structural adaptation does Nissen Fundoplication accomplish for GERD management?

Wraps the upper stomach around the lower esophagus Signup and view all the answers

What is the primary indication for performing a mesenteric defect repair?

To avoid bowel obstruction Signup and view all the answers

In open Nissen Fundoplication, how many permanent sutures are typically used to secure the stomach?

3-4 sutures Signup and view all the answers

What potential complication can arise if the mesenteric defect is not repaired during surgery?

Bowel obstruction Signup and view all the answers

What is the primary mechanism of Sleeve Gastrectomy?

By restricting the amount of food that can be consumed. Signup and view all the answers

Which type of surgery involves the placement of an adjustable band around the stomach?

Adjustable Laparoscopic Band Signup and view all the answers

At what age group is colorectal cancer most commonly diagnosed?

Adults aged 50 and older Signup and view all the answers

What is the initial sign of colorectal cancer?

Polyps Signup and view all the answers

Which surgical intervention requires the stapler type 'GIA' for right hemicolectomy?

Right Hemicolectomy Signup and view all the answers

Which mesenteric artery is involved with the removal of bowel segments during colorectal surgery?

Inferior Mesenteric Artery Signup and view all the answers

What is typically required after an Abdominal Peroneal Resection of the colon?

Colostomy Signup and view all the answers

Which of the following staplers is used in the sigmoid colectomy procedure?

EEA Signup and view all the answers

What is the primary use of the EEA technology in gastrointestinal procedures?

To reduce the need for permanent colostomies Signup and view all the answers

What type of anastomosis allows for the connection between two different sized lumens?

Side-to-Side Anastomosis Signup and view all the answers

Which device is specifically mentioned for performing a Side-to-Side Anastomosis?

GIA Stapler Signup and view all the answers

What is a key step in executing a Side-to-Side Anastomosis after bowel resection?

A GIA stapler is fired to staple the two bowel segments Signup and view all the answers

What type of anastomosis is often referred to as a Roux-en-Y?

End-to-Side Anastomosis Signup and view all the answers

What happens to the bowel after a Side-to-Side Anastomosis has healed?

It straightens out and functions similarly to an end-to-end anastomosis Signup and view all the answers

Which procedural step follows the insertion of the GIA stapler during a Side-to-Side Anastomosis?

The GIA stapler is fired by the surgeon Signup and view all the answers

How is the site left behind after a GIA stapler is removed typically managed?

It can be sutured closed or stapled with a TA stapler Signup and view all the answers

What is the primary reason for performing a temporary colostomy?

To allow the bowel to rest or heal an anastomosis Signup and view all the answers

Which type of colostomy is indicated when a rectal tumor is too close to the anus?

Abdominoperineal Resection Signup and view all the answers

What is the role of the purse-string suture in abdominoperineal resection?

To close the anus after bowel removal Signup and view all the answers

What happens to the distal part of the bowel during a Hartmann Colostomy?

It is closed and forms a mucous fistula Signup and view all the answers

Which surgical procedure eliminates the need for an ileostomy for patients with ulcerative colitis?

Ileal Anal Pull Through Signup and view all the answers

When is a Hartmann Colostomy typically performed?

In emergency situations Signup and view all the answers

What structure is typically used for a permanent rosebud colostomy?

Proximal bowel section Signup and view all the answers

What is the primary indication for performing an ileostomy?

Inflammatory bowel disease treatment Signup and view all the answers

Study Notes

Operating Room Considerations

An OR table must support excessive weight during bariatric surgeries to ensure patient safety.
Bowel/isolation technique is crucial to prevent cross-contamination and mechanical metastasis during GI surgeries.

Bowel Isolation Technique

Initiated once the GI tract is clamped, focusing on irrigation before wound closure.
Bowel instruments are kept separate from clean instruments; often passed off to the circulating nurse with the specimen.
Extra draping around the incisional area is recommended, with surgical team changing gloves post-anastomosis completion.

Stapling Devices Overview

GIA Stapler: Disposable, reloadable, cuts and staples, used for side-to-side anastomoses.
TA Stapler: Disposable, reloadable, staples tissues together with manual cutting required.
EEA Stapler: Disposable, not reloadable, cuts and staples for end-to-end or end-to-side anastomoses, often used to reduce colostomy needs.

Types of Anastomoses

End-to-End: Directly connects two bowel segments.
Side-to-Side (Functional End-to-End): Connects two segments after resection, allows for different lumen sizes, and functions like end-to-end after healing.
End-to-Side (Roux-en-Y): Joins one segment to the side of another, often for reconstructive purposes.

Mesenteric Repair

After bowel resection, it's critical to repair corresponding mesenteries to maintain blood supply from Superior and Inferior mesenteric arteries, preventing bowel entrapment and obstruction.

Procedures in GERD Management

Nissen Fundoplication: Addresses mechanical dysfunction of the lower esophageal sphincter; can be performed open or laparoscopically, forming a wrap around the lower esophagus.

Bariatric Surgical Procedures

Sleeve Gastrectomy: Removes 85% or more of the stomach to restrict food intake.
Adjustable Laparoscopic Band: Constricts the upper stomach, limiting food intake.

Colorectal Cancer Insights

Commonly occurs in the rectosigmoid area, particularly in those over 50. Early detection of polyps can lead to successful treatment.

Surgical Interventions for Colorectal Cancer

Right Hemicolectomy, Left Hemicolectomy, Transverse Colectomy, Anterior Resection, Sigmoid Colectomy, Abdominal Perineal Resection: Different approaches depending on cancer location and extent.

Colostomy/Ileostomy Creation

Temporary Colostomy: Allows bowel rest or anastomosis healing, often in emergency situations.
Permanent Colostomy: Required in cases like Abdominoperineal resection for rectal tumors.

Closure Techniques

Hartmann Colostomy: A colostomy done when a primary anastomosis isn't feasible; involves bringing out the proximal bowel to the skin while closing the distal stump.

Advanced Procedures

Ileal Anal Pull Through: Suitable for ulcerative colitis; removes the large bowel and part of the rectum, creating a pouch from the small bowel attached to the anus, maintaining sphincter control.

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Description

This quiz covers essential procedural considerations for bariatric and gastrointestinal surgeries, focusing on the importance of using specialized operating room tables for patient safety. Additionally, it addresses the bowel/isolation technique, which is vital in preventing cross-contamination during surgeries, especially cancer procedures.