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ABS Core Procedures
| Question | Answer |
|---|---|
| PD cath placement | Hassan technique Place catheter in dependent portion of pelvis. Exterioirize catheter with some tunneling in the skin with the cuff at the fascia Flush catheter and ensure it’s smooth with return of fluid as well |
| Abdominal wall reconstruction | Midline laparotomy Reduction of hernia sac/abdominal wall contents skin flaps Incise external oblique fascia place retrorectus mesh Bring midline together |
| Inguinal hernia repair | incise external oblique to the external inguinal ring dissect out the hernia sac and reduce preserve vas, vessels and, genitofemoral nerve 4a: tension free mesh reconstruction: soft tissue over the pubic tubercle (name?), conjoint tendon, shelving edge of |
| Femoral hernia | incise external oblique to the external inguinal ring retract the inferior leaf of the external oblique superiorly reduce the femoral hernia, pull neck up while applying counter pressure through the hernial mass 4a: place mesh plug in femoral space and su |
| Cholecystectomy | Infraumbilical Hassan expose the critical view of safety perform cholangiogram if indicated clip and divide duct and the artery take gallbladder off the cystic plate |
| Critical view of safety | first, only two structures can be clearly seen connected to the gallbladder; second, the lower one third of the gallbladder is separated from the liver to expose the cystic plate; third, the hepatocystic triangle must be completely clear of tissue allowin |
| Choledocoenteric anastomosis | Fashion roux limb: start at LOT count 10cm, divide bowel with stapler Bring roux limb up to the bile duct: sew back wall with 4-0 PDS before cutting into bowel, do duct to bowl mucosa anastomosis, interrupted PDS Count another 50cm below choledochoenteric |
| Choledochoscopy | "Incise cystic duct place wire, use baloon dilator to dilate duct hook cholecoscope up to saline, advance into duct Visualize stones, extract with wire basket, drive scope into duo if necessary withdraw scope, shoot competion cholangiogram" |
| CBD Exploration | "Longitudinal incision in CBD pass choledochoscope, make sure hooked up to saline visualize stones, extract with wire basket, pass fogarty Place t-tube and shoot cholangiogram Secure t-tube with 3-0 PDS" |
| Distal Pancreatectomy | 45degree right lateral decubitus hasson Lift up stomach and enter lesser sac through generous incision in omentum up to the short gastrics Tunnel under pancreas along SMV/portal vein Divide with thick stapler Dissect remainder of the pancreas off the |
| Pancreatic Debridement | "midline laparotomy Enter lesser sac through omentum or transverse colon Manually debride necrotic pancreat tissue Place large sump drains Place g-tube and feeding J-tube |
| Pancreatic Pseudocyst Drainage | Incise anterior stomach Aspirate contents with needle incise 3-4cm posterior stomach and some cyst wall, elipse this out, send cyst wall to path for frozen to be sure not cystic neoplasm with epithelial lining Running 3-0 pds suture for hemostasis to cre |
| Splenectomy | "Vaccinate for encapsultated organisms: pneumococcus, meningococcus, h-flu 45 degree right lateral decubutus Hassan supraumbilical Look for accessory spleen tissue in hilum, omentum Mobilize splenic flexure Enter lesser sac by dividing omentum, divid |
| "Splenectomy/Splenorrhaphy - Partial | "pledgeted 2-0 vicryl mattress sutures to repair isolated linear laceration in spleen apply neunet low threshold for splenectomy" |
| Antireflux Procedures | "Suptraumbilical hassan enter lesser sac through pars flaccida dissect along right crus, completely reducing/excising any hernia sac incise short gastrics and dissect along left crus Identify and protect the vagus nerves create 2cm floppy nissen wrap |
| "Cricopharyngeal Myotomy with Zenker's Diverticulum - Excision | Incision along anterior border of left SCM retract carotid sheath elements laterally perform myotomy over a 52fr bougie in the cricopharngeus, use right angle to elevate muscularis off of the mucosa staple off the diverticulum with a TA stapler over a |
| "Esophageal Perforation - Repair/Resection | "Use a swallow study to find the level of the perforation: cervical, upper 2/3 of chest, lower 1/3 chest, or abdomen Choose approach: cervical: anterior border of the SCM, upper 2/3 of chest: right posterolateral thoracotomy, lower 2/3 of chest: left tho |
Created by:
Skablime88