Surgical Anatomy and Techniques Quiz

Study Notes

Ligament of Treitz and Blood Supply

The Ligament of Treitz connects the duodenum to the jejunum.
Blood supply from the celiac trunk includes:
- Splenic artery
- Common hepatic artery
- Left gastric artery
Superior mesenteric artery supplies the small intestine, ascending colon, and two-thirds of the transverse colon.
Inferior mesenteric artery supplies the transverse colon to the rectum.

Surgical Techniques and Instrumentation

Abdomen sequence for surgical procedure: clamp, clamp, cut, tie.
Bowel isolation techniques prevent cross-contamination and mechanical metastasis of malignant cells.
Isolation begins once the gastrointestinal (GI) tract is clamped and opened, including irrigation before wound closure.
Bowel instruments are kept separate from clean instruments, stored in a K-basin on the table.
Extra draping may be applied around the incision for closure.
Surgical team must change gloves and gowns post-anastomosis and before closing the wound.

Staplers Used in Surgery

GIA (Gastrointestinal Anastomosis): cuts, staples, and divides simultaneously; suitable for side-to-side anastomosis; available in endoscopic form; accommodates different sized lumens.
TA (Thoracoabdominal Stapler): staples tissues together but requires manual cutting.
EEA (End to End Anastomosis) or ILS (Intraluminal Stapler): performs end-to-end or end-to-side anastomosis with a circular cutting method; primarily used for lower bowel.

Mesenteric Repair

Removal of bowel necessitates dissection of corresponding mesenteries, requiring repair of mesenteric defects.
Repair is essential to prevent post-operative bowel entrapment and obstruction.

Nissen Fundoplication

Consists of two components:
- Plication: folding stomach tissue around the esophagus to shorten it.
- Crurrorhaphy: permanent suture repair utilizing non-absorbable material.
Challenge lies in achieving optimal suturing tension; too loose can cause GERD, too tight can obstruct food passage.

Bariatric Surgery Procedures

Roux-En-Y Gastric Bypass: reduces stomach size and connects it to jejunum; bypasses duodenum; results in fewer calories absorbed and increased satiety.
Gastric Lap Band: adjustable band around the stomach to restrict ingested food volume.
Sleeve Gastrectomy: removes up to 85% of the stomach to limit food intake.

Colostomy/Ileostomy

Temporary colostomy may be performed to allow bowel rest during inflammatory disease or to heal anastomosis, serving to decompress a perforating bowel.
Hartmann’s Procedure: emergency colostomy to prevent bowel perforation or contamination; proximal end is brought out for normal fecal drainage, distal stump is closed as a mucous fistula.
In about three months, the bowel may be reconnected by anastomosing the distal stump with the proximal colostomy.
Permanent colostomy, referred to as "Rosebud colostomy," occurs after bowel resection for cancer.

Abdominoperineal Resection

Indicated when a rectal tumor is too large or close to the anus for traditional surgery.
Involves resection of the lower sigmoid colon, rectum, and anus, performed through both abdominal and perineal incisions.
Requires a two-team approach with two scrub nurses, separate count sheets, and dual surgical setups.

Description

Test your knowledge on the anatomy of the Ligament of Treitz and the blood supply involved in gastrointestinal surgery. This quiz includes surgical techniques and instrumentation practices essential for procedures involving the GI tract. Review important aspects of bowel isolation and proper handling of surgical instruments.