COMMON PROCEDURES

Midline laparotomy

Incision down the middle of abdomen

along and through the linea alba:

McBurney’s

Small, oblique right lower quadrant incision

for an appendectomy through McBurney’s

point (one third from the anterior superior

iliac spine to the umbilicus):

Chapter 10 / Incisions 75

Rocky-Davis

Like a McBurney’s incision except

transverse (straight across):

hrf

Pfannenstiel

Low transverse abdominal incision with

(“fan-en-steel”)

retraction of the rectus muscles laterally;

most often used for gynecologic

procedures:

Kidney transplant

Lower quadrant; kidney placed

extraperitoneally:

Liver transplant

Chevron or Mercedes-Benz® incision in

the upper abdomen:

Median sternotomy

Midline sternotomy incision for heart

procedures; less painful than a lateral

thoracotomy:

Thoracotomy

Usually through the fourth or fifth

intercostal space; may be anterior or

posterior lateral incisions

Very painful, but many are performed

with muscle sparing (muscle retraction

and not muscle transection):

Chapter 10 / Incisions 77

CEA (carotid

Incision down anterior border of the

endarterectomy)

sternocleidomastoid muscle to expose the

carotid:

Laparoscopic

Four trocar incisions:

cholecystectomy

Common

Roux

limb

bile duct

Brooke ileostomy

Standard ileostomy that is folded on

itself to protrude from the abdomen

2 cm to allow easy appliance placement

and collection of succus

CEA

Carotid EndArterectomy; removal of ath-

erosclerotic plaque from a carotid artery

Bassini herniorrhaphy

Repair of inguinal hernia by approximat-

ing transversus abdominis aponeurosis

and the conjoint tendon to the reflection

of Poupart’s (inguinal) ligament

McVay herniorrhaphy

Repair of inguinal hernia by

approximating the transversus abdominis

aponeurosis and the conjoint tendon to

Cooper’s ligament (which is basically the

superior pubic bone periosteum)

Lichtenstein

“Tension-free” inguinal hernia repair using

herniorrhaphy

mesh (synthetic graft material)

of the transversalis fascia, transversus

abdominis aponeurosis, and the conjoint

tendon and approximation of the trans-

versus abdominis aponeurosis and the

conjoint tendon to the inguinal ligament

Plug and patch hernia

Prosthetic plug pushes hernia sac in and

repair

then is covered with a prosthetic patch to

repair inguinal hernias

APR

AbdominoPerineal Resection; removal

of the rectum and sigmoid colon through

abdominal and perineal incisions (patient

is left with a colostomy); used for low

rectal cancers 8 cm from the anal verge

LAR

Low Anterior Resection; resection of

low rectal tumors through an anterior

abdominal incision

Hartmann’s procedure

1. Proximal colostomy

2. Distal stapled-off colon or rectum that

is left in peritoneal cavity

Mucous fistula

Distal end of the colon is brought to the

abdominal skin as a stoma (proximal end

is brought up to skin as an end colostomy)

Kocher (“koh-ker”)

Dissection of the duodenum from the

maneuver

right-sided peritoneal attachment to

allow mobilization and visualization of

the back of the duodenum/pancreas

Chapter 14 / Surgical Operations You Should Know 85

Seldinger technique

Placement of a central line by first placing

a wire in the vein, followed by placing the

catheter over the wire

Cricothyroidotomy

Emergent surgical airway through the

cricoid membrane

Hepaticojejunostomy

Anastomosis between a jejunal roux limb

and the hepatic ducts

Puestow procedure

Side-to-side anastomosis of the pancreas

and jejunum (pancreatic duct is filleted

open)

Stamm gastrostomy

Gastrostomy placed by open surgical

incision and tacked to the abdominal

wall

Highly selective

Transection of vagal fibers to the body

vagotomy

of the stomach without interruption of

fibers to the pylorus (does not need

pyloroplasty or other drainage procedure

because the pylorus should still function)

Enterolysis

Lysis of peritoneal adhesions

LOA

Lysis Of Adhesions (enterolysis)

Appendectomy

Removal of the appendix

Lap appy

Laparoscopic removal of the appendix

Cholecystectomy

Removal of the gallbladder

Lap chole

Laparoscopic removal of the gallbladder

Nissen

Nissen fundoplication; 360 wrap of the

stomach by the fundus of the stomach

around the distal esophagus to prevent

reflux

Lap Nissen

Nissen fundoplication with laparoscopy

Simple mastectomy

Removal of breast and nipple without

removal of nodes

Choledochojejunostomy

Anastomosis of the common bile duct to

the jejunum (end to side)

Graham patch

Placement of omentum with stitches over

a gastric or duodenal perforation (i.e.,

omentum is used to plug the hole)

Heineke-Mikulicz

Longitudinal incision through all layers of

pyloroplasty

the pylorus, sewing closed in a transverse

direction to make the pylorus nonfunctional

(used after truncal vagotomy)

Pringle maneuver

Temporary occlusion of the porta hepatis

(for temporary control of liver blood flow

when liver parenchyma is actively bleeding)

Modified radical

Removal of the breast, nipple, and axillary

mastectomy

lymph nodes (no muscle is removed)

Lumpectomy and

Removal of breast mass and axillary

radiation

lymph nodes; normal surrounding breast

tissue is spared; patient then undergoes

postoperative radiation treatments

I & D

Incision and Drainage of pus; the wound

is then packed open

Exploratory laparotomy

Laparotomy to explore the peritoneal cav-

ity looking for the cause of pain, peritoneal

signs, obstruction, hemorrhage, etc.

TURP

TransUrethral Resection of the Prostate;

removal of obstructing prostatic tissue via

scope in the urethral lumen

Fem pop bypass

FEMoral artery to POPliteal artery

bypass using synthetic graft or saphenous

vein; used to bypass blockage in the

femoral artery

PEG

Percutaneous Endoscopic Gastrostomy:

Endoscope is placed in the stomach,

which is then inflated with air; a needle is

passed into the stomach percutaneously,

wire is passed through the needle

traversing the abdominal wall, and the

gastrostomy is then placed by using the

Seldinger technique over the wire

Guidewire

Snare

Tube

Ileoanal pull-through

Anastomosis of the ileum to the anus

after total proctocolectomy

Hemicolectomy

Removal of a colonic segment

(i.e., partial colectomy)

Truncal vagotomy

Transection of the vagus nerve trunks;

must provide drainage procedure to

stomach (e.g., gastrojejunostomy or

pyloroplasty) because after truncal

vagotomy, the pylorus does not relax

Vagus nerves

Truncal vagotomy