I

l6 .

Surgicot procedures tncluding Minimol Access procedures

Gostrointestinotsurgery

II/

Supplies Basin set Blades (2) No. 10, (1) No. lb Needle magnet or counter $.astrostomy catheter (e.g., Foley, pezzer) Electrosurgical pencil Suction tubing Hemoclips (assorted)

Rocedure lte incision may be upper niidline or bilateral sub@stal. For total gastrectomy a thoracoabdominal inci-

irn

Catheter plug

SpeciolNotes
stomach is made.
GASTRECTOMY

Have suction ready as soon as the incision into the

Definition
Removal of
Discussion

continuity of the gastrointestinal tract.

the stomach and reestablishment of the

spleen) arr removed .. Total gastrectomy is often performed because of maIrgnancy or uncontrollable bleeding. Continuity ofthe gastr-ointestinal tract is establisheld by ana.stomosing distal esophag.us to the proximal jeju"J-, *itfr thecreatio-n of a pouch o" ,"s""rnoi". (the duodunum "r"uffy or an isolated segment of colon can also *"pi"* the re_ sected stomach.) The lymph nodes, aaja^cenJ organs, and greater omentum aie removed i"fr"iii""uti"f *"i lignancies.

ulcer disease or tumor ol the distaf stomaatr. a vaiotomy (see pp. 106-102) may be included. Gasirointe"stinal continuity is reest.ablished by anastomosing of the gastrig remnant to the proximal-duodenum l-Siir"th i) to tI9 p"g-Limal jejunum (Billroth II, or a'modifica9." [ron ot rt). When treating malignancies, the greater omentum, lymph nodes, and ad.jacent organi (e.g.,

Subtotal (p_artial) gast:rectomy refers to the excision of a portion of the stomach performed primarily for p"pti.

nfuues may be employed. A side-to-side jejunaipouch Tty !e required when total gastrectomyis performed. .{draln (e.g., Jackson-Pratt or Hemovac) is inserted. If fu_ pleural space has been entered, an intrapleural sled drainage unit (e.g., pleurevac) is necessary. The round is closed in layers. Drains are anchored. -

NDes, or a wide variety of sutures and suturing t-ech_

Gc*ed in continuity with the stomach blo. when mahgnancy is present. According to the "r, extent of the recction and the type of anastomosis to be fashioned, the ftoilenum or jejunum is mobilized and anastomosed to the gastric remnant (or distal esophagus) anterior or lnsterior to the transverse colon. A retrocolic anastonosis requires an incision to be made in a relatively rvascular portion ofthe transverse mesocolon. Anastorcis is facilit_ated by the use of automatic stapling de-

rts operabrlrty assessed. The stomach is mobilized by damping and dividing the vascular attachments. ThL greater omentum and sometimes the spleen are re-

may.be.necessary. The pathology is identified., and

Freporotion of the potient

hran upper midline

lnticnt is supine. For a thoracoabdominal api"oactr, ttre lntient is in a modified (4b") lateraVsims,position with -'gleft side uppermost.
may be used;. The right lei is crtended, and the left leg is flexed with'a pillow-betwJen the feet a"i $l 1",*: gd ngadlls around be necessary anktes. e pitlongitudinally may to support ihe .hIblded posrtron EcK. l'he rs sec-uted by wide adhesive tape from tre shoulders, hips, and legs to the table. Appty nrgical dispersive pad. "t".t"o-

or bilateral subcostal approach, the

*ft y* ais sulr.norted by a-Mayo stand padded *itt u piil .bw (or double armboard

The right arm is on an a"mbou"d;

Sdn Preporotion
begin at incision extending from

For an upper midline or bilateral subcostal approach,

tt ,.iff" i":.ist above "