Operative Procedures in Surgical Gastroenterology (2 Volumes) SP Kaushik
INDEX
A
AIIMS experience about PLR shunt 225
Anastomosis 14 73, 214, 247, 261, 338, 342, 353, 355
B
Benign biliary stricture surgery 122
classification of biliary stricture 124
incision 125
indications 122
position of patient 125
postoperative care 132
preoperative preparation 123
steps of operation 125
closure 132
dissection of the duct 127
drain 131
hepaticojejunostomy 129
hilar dissection 126
mobilization of the liver 125
preparation of the Roux loop 128
preparation of the stoma 127
stents and access loop 130
subhepatic dissection 126
C
Calot's triangle 92, 97, 106
Cholecystectomy 90
closure 94
drain 93
extended 104
closure 109
drain 109
incision 105
indications 104
position of the patient 105
postoperative care 109
preoperative preparation 104
step of operation 105
incision 91
indications 90
postoperative care 94
preoperative preparation 90
steps of operation 91
Choledochal cyst 112
recommended surgical options 113
closure 117
drain 117
incision 114
indications 114
position of patient 114
postoperative care 117
preoperative preparation 114
steps of operation 144
Cholangiojejunostomy 138
closure 145
contraindications 138
drain 145
incision 139
indications 138
position of patient 139
postoperative care 145
preoperative preparation 139
steps of operation 140
hepatic parenchyma approach 142
hepaticojejunostomy 143
ligamentum teres approach 141
E
Emergency ward posting 376
G
Gastrojejunocolic fistula 80
closure 85
drain 85
incision 82
indication of surgery 81
position of patient 82
postoperative care 85
preoperative preparation 81
steps of operation 82
Gastrotomy 217
Gonzale's operation 280
Good practices in surgery 370
Group of regional lymph nodes 72, 108
H
Hartman's pouch 92, 98
Hepatectomy 149
closure 160
drain 160
incision 153
indications
hilar bile duct tumours 150
liver tumours 150
living related liver transplantation 151
trauma 151
position of patient 152
postoperative care 160
preoperative preparation 151
steps of operations 154
left hepatectomy 159
right hepatectomy 158
Hepaticojejunostomy 129, 143
Highly selective vagotomy 44
anatomical considerations 45
incision 45
indications 44
position of patient 45
postoperative care 49
preoperative preparation 44
steps of operation 46
I
Ileostomy 311
closure 319, 323
drain 319
incision 315
indications
end ileostomy 312
loop ileostomy 313
position of patient 315
postoperative care 319
preoperative preparation 313
bowel preparation 314
counselling 313
stoma site 313
results and complications 320
dermatological 322
ileostomy obstruction 323
ischaemic 321
metabolic 320
paraileostomy fistula 323
prolapse of ileostomy 322
retraction 322
stenosis 323
steps of operation 315
variations 317
end loop ileostomy 318
loop ileostomy 317
split ileostomy 318
Indoor ward posting 377
Interposition H-graft portacaval shunts 243
contraindications 244
incision 245
indications 243
position of patient 245
postoperative care 250
preoperative preparation 244
SGPGIMS experience 252
steps of operation 245
anastomosis 247
assessment of shunt patency 248
closure 250
drains 250
graft preparation 246
ligation of collaterals 249
M
Mirizzi syndrome 96
cholecysectomy 97
closure 100
drain 100
incision 97
postoperative care 100
preoperative preparation 97
steps of operation 97
types 96
Morrison's pouch 154
O
Oesophagogastric devascularisation 178
classical Sugiura procedures 179
contraindications 179
indications 178
Mathur's modification 182
closure 184
dealing with oedematous friable oesophagus 184
drain 184
incision 182
position of patient 182
postoperative care 184
rationale for avoiding splenectomy 183
steps of operation 182
preoperative preparation 179
result of Sugiura procedure 185
steps of operation 180
abdominal dissection 181
minor modifications of Sugiura technique 181
pros and cons of using the stapler 181
thoracic dissection 180
Oesophagojejunal anastomosis 73
Operation room 379
Operation theatre procedures/dressings 376
P
Pancreatic necrosectomy 285
incision 288
indications 286
position of patient 287
postoperative care 293
preoperative preparation 286
steps of operation 288
closure 292
drain 292
feeding jejunostomy 291
management of residual cavity 290
special situations 289
Pancreaticoduodenectomy 255
anastomosis 263
choledochojejunostomy 264
closure 265
drain 265
feeding jejunostomy 264
gastro/duodenojejunostomy 264
incision 257
indications 256
pancreaticojejunostomy advantages 262
disadvantages 262
pancreatogastrostomy advantages 261
anastomosis 261
position of patient 257
postoperative care 266
preoperative preparation 256
steps of operation 257
Pancreaticojejunostomy 262, 269
closure 279
drain 279
incision 273
indications
chronic pancreatitis 271
pancreatic malignancy 272
pancreatic trauma 272
modifications 280
position of patient 273
postoperative care 280
postoperative complications 281
preoperative preparation 272
steps of operation 273
Portal hypertension 178, 188, 242
Proximal lienorenal shunt 203
AIIMS experience 225
incision 208
indications
elective 204
emergency 205
intraoperative monitoring 209
position of patient 208
postoperative care 219
preoperative preparation
elective cases 205
emergency cases 206
review of literature 224
steps of operation 209
anastomosis 214
closure 218
complete haemostasis 218
constructing a proximal lienorenal shunt 213
drain 218
gastrotomy 217
left renal vein mobilisation 211
splenic vein mobilisation 209
Pyloroduodenostomy 59
closure 63
drain 63
incision 61
indications 60
postoperative care 64
preoperative preparation 60
steps of operation 61
R
Radical gastrectomy 66
complications 76
incision 68
indications
elective 66
emergency 67
position of patient 68
postoperative care 75
preoperative preparation 67
steps of operation 68
Radical oesophagectomy 31
incision 35
indications 32
position of patient 35
postoperative care 39
preoperative preparation 33
steps of operation 35
abdominal dissection 37
cervical dissection 38
closure 39
drain 39
mediastinal dissection 35
Research/academic activities 379
Resection of rectum 327
closure 343
contraindications 330
drain 343
incision 333
indications 329
grade of tumour 330
location of tumour 329
size and mobility of tumour 329
tumour fixation 330
position of patient 332
postoperative care 343
preoperative preparation 331
bowel preparation 332
counseling 332
histopathology 331
imaging 331
steps of operation 333
anastomosis 338
anterior dissection 337
checking the anastomosis 342
defunctioning stoma 342
double staple technique 341
extended resection 337
handsewn anastomosis 339
lateral dissection 336
ligation of inferior mesenteric vessels 334
looping of ureters 334
mobilization of rectum 334
posterior dissection 334
single staple technique 340
splenic flexure mobilisation 333
stapled anastomosis 340
total mesorectal excision 336
Resection of the quadrate lobe 164
incision 166
indications 164
position of patient 166
postoperative care 173
preoperative preparation 164
steps of operation 166
marking the segment IV 171
haemostasis and closure 172
isolation of inflow vessels 170
mobilisation of liver 168
parenchymal transaction 171
portal dissection 169
surgical anatomy 167
Resident responsibilities and functions 374
Resident's logbook
Restorative proctocolectomy 345
closure
pouch construction 354
W pouch 354
drain 354
incision 348
indications 346
position of patient 347
postoperative care 355
postoperative complications 355
preoperative preparation 347
steps of operation 348
handsewn technique 351
handsewn vs stapled anastomosis 353
loop ileostomy 353
mucosal proctectomy 351
pouch anal anastomosis 352
pouch construction 349
proctocolectomy 348
stapled technique 351
technique of J pouch construction 350
Roux en Y loop formation 298
incision 303
indications 298
postoperative care 307
preoperative preparation 302
procedures 298
duodenal switch operation 300
Roux en Y cholecystojejunostomy 302
Roux en Y gastric bypass operation 300
Roux en Y gastrojejunostomy 298
Roux en Y gastrojejunostomy 301
Roux en Y hepaticojejunostomy 299
Roux en Y jejunal limb 301
Roux en Y jejunostomy 302
Roux en Y oesophagojejunostomy 298
Roux en Y pseudocystojejunostomy 300
uncut Roux en Y gastrojejunostomy 301
vagotomy, antrectomy 302
steps of operation 303
closure 307
drain 307
role of stents 306
use of staplers 306
Roux en Y oesophagojejunostomy 73
S
Sengstaken-Blakemore tube 207
Seromyotomy 52
anatomical considerations 53
incision 52
indications 52
position of a patient 52
postoperative care 57
preoperative preparation 52
steps of operation 53
Side to side lienorenal sunt 234
closure 239
drain 238
incision 236
indications 234
position of patient 236
postoperative care 239
preoperative preparation 235
steps of operation 236
Splenectomy 188
closure 199
contraindication 188
drain 199
incision 190
indications 188
position of patient 189
postoperative care 199
preoperative preparation 188
steps of operation 190
complete haemostasis 196
gastrocolic ligament division 192
gastroplenic ligament division 192
lienorenal and splenophrenic ligaments divisions 194
removal of large, adherent spleens 197
splenectomy in segmental portal hypertension 196
splenic artery ligation 193
splenic vein and other hilar vessels division 195
splenocolic ligament division 193
Split pancreaticojejunostomy 280
Sugiura's procedure 178
Surgical anatomy of the liver 158
T
Total proctocolectomy 359
closure 364
drain 364
incision 362
indications 360
position of patient 362
postoperative care 364
preoperative preparation 362
steps of operation
colonic mobilisation 362
ileal division 364
ileostomy 364
mesenteric dissection 362
perineal dissection 364
vascular division 363
Transhiatal oesophagectomy 2
contraindication 3
functional status after/
operation 29
incision 4
indications 2
intraoperative complications 18
cardiac complications 24
conduit complications 25
haemorrhage 18
pleural complications 21
recurrent laryngeal nerve injury 25
tracheal tear 22
morbidity and mortality 17
position of patient 4
postoperative care 15
postoperative complications 26
preoperative operation 3
steps of operation
abdominal 5
cervical 8
cervical oesophagogastric anastomosis 14
closure of abdominal wound 14
delivery of the oesophagus 11
division of oesophagus in the neck 11
mediastinal 10
mobilization of the cervical oesophagus 9
mobilization of the oesophages 7
posterior dissection 10
preparation of gastric tube 12
removal of the specimen 12
transposition of the stomach 13
Truncal vagotomy 52
U
Ulcerative colitis 360
×
Chapter Notes

Save Clear


1Operative Procedures in Surgical Gastroenterology2
3Operative Procedures in Surgical Gastroenterology
Volume I Editor SP Kaushik MBBS (Lko) FRCS (Edin) PhD (London) FICS FACG FAMS (Academy of Medical Sciences, India) FormerProfessor and Head, Department of Surgical Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow, India Professor and HeadDepartment of Surgery Government Medical College and Hospital Chandigarh, India PresidentIndian Association of Surgical Gastroenterology Member, Governing Council Association of Surgeons of India Indian Society of Gastroenterology AdvisorIndian Armed Forces Rajiv Gandhi Cancer Institute and Research Centre New Delhi, India Foreword Prof Michael Hobsley
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, Phone: +91-11-43574357
Registered Office
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021
+91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683
Branches
  • 2/B, Akruti Society, Jodhpur Gam Road Satellite
    Ahmedabad 380 015, Phones: +91-79-26926233, Rel: +91-79-32988717
    Fax: +91-79-26927094, e-mail: ahmedabad@jaypeebrothers.com
  • 202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park East
    Bengaluru 560 001, Phones: +91-80-22285971, +91-80-22382956, 91-80-22372664
    Rel: +91-80-32714073, Fax: +91-80-22281761 e-mail: bangalore@jaypeebrothers.com
  • 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza, Pantheon Road
    Chennai 600 008, Phones: +91-44-28193265, +91-44-28194897, Rel: +91-44-32972089
    Fax: +91-44-28193231 e-mail: chennai@jaypeebrothers.com
  • 4-2-1067/1-3, 1st Floor, Balaji Building, Ramkote Cross Road,
    Hyderabad 500 095, Phones: +91-40-66610020, +91-40-24758498
    Rel:+91-40-32940929, Fax:+91-40-24758499 e-mail: hyderabad@jaypeebrothers.com
  • No. 41/3098, B & B1, Kuruvi Building, St. Vincent Road
    Kochi 682 018, Kerala, Phones: +91-484-4036109, +91-484-2395739
    +91-484-2395740 e-mail: kochi@jaypeebrothers.com
  • 1-A Indian Mirror Street, Wellington Square
    Kolkata 700 013, Phones: +91-33-22651926, +91-33-22276404
    +91-33-22276415, Rel: +91-33-32901926, Fax: +91-33-22656075
  • Lekhraj Market III, B-2, Sector-4, Faizabad Road, Indira Nagar
    Lucknow 226 016 Phones: +91-522-3040553, +91-522-3040554
  • 106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital, Parel
    Mumbai 400 012, Phones: +91-22-24124863, +91-22-24104532,
    Rel: +91-22-32926896, Fax: +91-22-24160828
  • “KAMALPUSHPA” 38, Reshimbag, Opp. Mohota Science College, Umred Road
    Nagpur 440 009 (MS), Phone: Rel: +91-712-3245220, Fax: +91-712-2704275
USA Office
1745, Pheasant Run Drive, Maryland Heights (Missouri), MO 63043, USA, Ph: 001-636-6279734 e-mail: jaypee@jaypeebrothers.com, anjulav@jaypeebrothers.com
Operative Procedures in Surgical Gastroenterology Volume I
© 2009, SP Kaushik
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition: 2001
Second Edition: 2009
9788184485691
Typeset at JPBMP typesetting unit
Printed at
5To My Parents Wife and Children6
7CONTRIBUTORS
  • N Ananthakrishnan
  • Professor and Head
  • Department of Surgery
  • Jawaharlal Nehru Institute of Postgraduate Medical Education and Research
  • Pondicherry
  • A Behari
  • Senior Resident
  • Department of Surgical GE
  • Sanjay Gandhi PGI
  • Lucknow
  • Debanshu Bhaduri
  • Department of Surgical Oncology
  • Tata Memorial Hospital
  • Mumbai
  • Abhijit Chandra
  • Senior Resident
  • Department of GI Surgery
  • GB Pant Hospital, New Delhi
  • TK Chattopadhyaya
  • Professor and Head
  • Department of GI Surgery
  • AIIMS, New Delhi
  • A Chaudhary
  • Professor and Head
  • Department of GI Surgery
  • GB Pant Hospital
  • New Delhi
  • 8D Dahiya
  • Senior Resident
  • Department of Surgery
  • PGIMER
  • Chandigarh
  • DN Dwivedi
  • Senior Resident
  • Department of Surgery
  • AIIMS, New Delhi
  • Sanjiv P Haribhakti
  • Hon Assistant Professor
  • Gastroenterology Surgery
  • Seth VS General Hospital and HL Medical College
  • Ahmedabad
  • Md Ibrarullah
  • Assistant Professor and Head
  • Department of Gastroenterology
  • Sri Venkateshwara Institute of Medical Sciences
  • Tirupati
  • P Jagannath
  • Consultant Surgeon
  • Department of Surgical Oncology
  • Tata Memorial Hospital
  • Mumbai
  • VK Kapoor
  • Professor and Head
  • Department of Surgical GE
  • Sanjay Gandhi PGI
  • Lucknow
  • 9SP Kaushik
  • Professor and Head
  • Department of Surgery
  • GMCH, Chandigarh
  • Ashok Kumar
  • Assistant Professor
  • Department of Surgical GE
  • Sanjay Gandhi PGI
  • Lucknow
  • PK Mishra
  • Assistant Professor
  • Department of Surgery
  • University College of Medical Sciences, New Delhi
  • SK Mitra
  • Ex-Professor of Paediatric Surgery PGIMER
  • Chandigarh
  • SK Mathur
  • Consultant GE Surgeon
  • Bombay Hospital and Medical Research Center
  • Mumbai
  • KL Narasimhan
  • Assistant Professor
  • Department of Paediatric Surgery
  • PGIMER
  • Chandigarh
  • Sujoy Pal
  • Senior Resident
  • Department of Surgery
  • AIIMS
  • New Delhi
  • 10GK Pande
  • Assistant Professor
  • Department of GI Surgery
  • AIIMS
  • New Delhi
  • P Radhakrishna
  • Senior Resident
  • Department of Surgical GE
  • Nizam Institute of Medical Sciences
  • Hyderabad
  • H Ramesh
  • Assistant Director and Chief Surgeon
  • Digestive Diseases Center
  • PVS Memorial Hospital
  • Cochin
  • KLN Rao
  • Professor and Head
  • Department of Paediatric Surgery, PGIMER
  • Chandigarh
  • KV Ravindra
  • Assistant Professor
  • Department of Surgery
  • St John's Medical College
  • Bengaluru
  • Ajay K Sachdev
  • Additional Professor
  • Department of GI Surgery
  • GB Pant Hospital
  • New Delhi
  • 11Peush Sahni
  • Assistant Professor
  • Department of Surgery
  • AIIMS
  • New Delhi
  • Anuj Sarkari
  • Senior Resident
  • Department of Surgical GE
  • Sanjay Gandhi PGI
  • Lucknow
  • RA Sastry
  • Professor
  • Department of Surgical GE
  • Nizam Institute of Medical Sciences
  • Hyderabad
  • Sadiq S Sikora
  • Associate Professor
  • Department of Surgical GE
  • Sanjay Gandhi PGI
  • Lucknow
  • PG Thomas
  • Professor
  • Department of Surgery
  • St John's Medical College, Bengaluru
  • GD Wagholikar
  • Senior Resident
  • Department of Surgical GE
  • Sanjay Gandhi PGI, Lucknow
  • JD Wig
  • Additional Professor
  • Department of Surgery
  • PGIMER
  • Chandigarh12
13FOREWORD
Textbooks describing surgical operations abound, but Prof Kaushik's Operative Procedures in Surgical Gastroenterology incorporates some features of special importance.
Firstly, it is devoted to surgical gastroenterology, a specialty that is only recently beginning to develop— an advance that owes much to the dedicated zeal of Prof Kaushik himself.
Secondly, the list of contributors is impressive: it comprises those who are not only the colossi of the surgical stage but well-known actors in the world theatre of surgery. The reader can confirm this by checking the bibliography for further reading at the end of each chapter.
Thirdly, its intended readers are specified in Prof Kaushik's Preface as aspiring young surgeons, not necessarily those about to specialise in gastroenterological surgery. He realises well that most surgeons in the world, have to take wider responsibilities on their shoulders as ‘general’ surgeons, but it remains true that the problems of the alimentary tract dominate their labours and provide a real challenge to their skills. For this reason, the information about each operation is provided in terse, lucid prose with careful definitions of all terms used, and with a brief historical introduction to set the information in context. There 14is a justifiable concentration on indications and adequate discussion of preparation for operation, aftercare and complications, and alternative methods of management where practice has still not been codified into a ‘best bet’.
My own ‘best bet’ is, that this book will be a winner. I congratulate Prof Kaushik and his colleagues and wish them success.
Michael Hobsley
FRCS, MCh, PhD, DSc (Med)
Emeritus Professor
University College and Middlesex Hospital and
Medical School, London
Fellow of the Association of Surgeons of India
and the American Surgical Association
15PREFACE
In the career graph of a surgeon, choosing a highly specialised surgical field of work, is one of the most challenging experiences. To be able to achieve it successfully is indeed a matter of great satisfaction. The excitement and the thrills of performing a specialised surgical technique and taking it to its logical end point, in accordance to the health care needs of a community/country, elevates the level of this satisfaction further to almost an ecstasy. If one looks back to his/her entry point into a medical college, it is a rather long and arduous journey.
The ability to perform successfully an operative procedure on a patient is the most important part of a surgeon's commitment. The operative procedures described in this book are all major gastroenterological surgeries, which a budding and aspiring surgeon needs to learn and perform under guidance and supervision of great teachers in institutionalised set-ups. The book is only meant to be a support, to learn the basic indications, steps of operation and postoperative care. It should help a young faculty, an MCh/MS postgraduate and a practitioner of surgery, to remember the basics and essential steps, inside and/ or outside the operation theatre complex.
I am highly indebted to my professional colleagues, who have contributed their write-ups to this volume. 16They are all well-known experts in the superspecialty of surgical gastroenterology in this country and are very busy practitioners in their profession. I am grateful to them for having spared their time to write on request.
The best possible reward for the author would be if the book is able to help and contribute even to a small measure, making of Great Surgeons of tomorrow.
SP Kaushik171819