WARNING:
JavaScript is turned OFF. None of the links on this concept map will
work until it is reactivated.
If you need help turning JavaScript On, click here.
This Concept Map, created with IHMC CmapTools, has information related to: resection intra-op, STEP 10 - Place a simple interrupted suture at mesenteric to appose intestinal ends. Mesenteric fat be be removed if necessary to properly visualize and place the suture. STEP 11 - A second suture should be placed at the antimesenteric border, approximately 180 degrees from the first. The purpose of this is to divide the suture lines into 2 equal halves. If luminal diameter is equal, additional sutures should be spaced within the first 1 sutures approximately 2mm from the edges and 2-3mm apart., STEP 5 - Chyle from the lumen must be gently milked out from the segment of intestine to be transected and the lumen is to be occluded at both ends of the segment in order to minimize leakage of the intestinal contents STEP 6 - Forceps (either crushing or non-crushing) should be placed at each end of the affected bowel segment. The forcep used can be either crushing or non-crushing because this segment of bowel is to be removed in any case, STEP 6 - Forceps (either crushing or non-crushing) should be placed at each end of the affected bowel segment. The forcep used can be either crushing or non-crushing because this segment of bowel is to be removed in any case STEP 7 - The intestine is to be transected using a scalpel or Metzenbaum scissors, along the outside of the forceps. This incision can be made either perpendicular or oblique to the long axis of the intestine. Make the oblique incision so that the antimesenteric border is shorter than the mesenteric border. Any everted mucosa can be trimmed with Metzenbaum scissors if necessary, just prior to starting the end-to-end anastomosis. Polyproylene/nylon is indicated in cases of neoplastic disease/peritonitis., STEP 11 - A second suture should be placed at the antimesenteric border, approximately 180 degrees from the first. The purpose of this is to divide the suture lines into 2 equal halves. If luminal diameter is equal, additional sutures should be spaced within the first 1 sutures approximately 2mm from the edges and 2-3mm apart. STEP 12 - After placement of the sutures, inspect the anastomosis and check for leakage in a similar manner which is performed for enterotomies. *Important to note that any anastomosis can have leakage if enough pressure is applied therefore this is a subjective leak test. If leaks are noted with moderate pressure, place additional sutures and recheck for leakage., STEP 7 - The intestine is to be transected using a scalpel or Metzenbaum scissors, along the outside of the forceps. This incision can be made either perpendicular or oblique to the long axis of the intestine. Make the oblique incision so that the antimesenteric border is shorter than the mesenteric border. Any everted mucosa can be trimmed with Metzenbaum scissors if necessary, just prior to starting the end-to-end anastomosis. Polyproylene/nylon is indicated in cases of neoplastic disease/peritonitis. STEP 8 - Simple interrupted sutures are to be placed through all layers of intestinal wall. The needle should be angled to engage the serosa a bit further from the edge than the mucosa. This will help in the prevention of mucosal evertion., STEP 3 - Assess the viability of the intestine to determine the amount of bowel that must be removed/resected. Intestinal viability can be determined by palpation, color, or the pinch test. The pinch test involves pinching a section of bowel to note if a peristaltic wave can be initiated STEP 4 - With a simple interrupted suture, double ligate and transect the arcadial mesenteric vessels from cranial mesenteric artery which supplies the segment/section of intestine which is to be removed. Following this, also double ligate terminal arcade vessels within mesenteric fatat the points of proposed intestinal transection, STEP 13 - The mesenteric incision should be closed with either a simple interrupted or continuous suture pattern. *Ensure that the arcadial vessel near the defect is not damaged/penetrated. STEP 14 - Thoroughly lavage the abdomen and anastomotic site with warm saline prior to closure of the abdomen., STEP 2 - Exteriorize and isolate the affected/diseased section of the intestine from the abdomen by packing with laparotomy sponges/towels STEP 3 - Assess the viability of the intestine to determine the amount of bowel that must be removed/resected. Intestinal viability can be determined by palpation, color, or the pinch test. The pinch test involves pinching a section of bowel to note if a peristaltic wave can be initiated, STEP 1 - Make an abdominal incision (from xyphoid to pubis) that is long enough to allow exploration of the abdomen STEP 2 - Exteriorize and isolate the affected/diseased section of the intestine from the abdomen by packing with laparotomy sponges/towels, RESECTION and ANASTOMOSIS INTRA-OP PROCEDURE STEP 1 - Make an abdominal incision (from xyphoid to pubis) that is long enough to allow exploration of the abdomen, STEP 8 - Simple interrupted sutures are to be placed through all layers of intestinal wall. The needle should be angled to engage the serosa a bit further from the edge than the mucosa. This will help in the prevention of mucosal evertion. STEP 9 - Each suture should be carefully tied to appose all layers of the intestine and the knots should be located extraluminally. Here a simple continuous suture pattern is used. *Note that pulling a simple continuous suture too tight will result in a purse string effect which is not desireable as it may compromise the intestinal lumen diameter, further resulting in obstruction or stenosis., STEP 12 - After placement of the sutures, inspect the anastomosis and check for leakage in a similar manner which is performed for enterotomies. *Important to note that any anastomosis can have leakage if enough pressure is applied therefore this is a subjective leak test. If leaks are noted with moderate pressure, place additional sutures and recheck for leakage. STEP 13 - The mesenteric incision should be closed with either a simple interrupted or continuous suture pattern. *Ensure that the arcadial vessel near the defect is not damaged/penetrated., STEP 9 - Each suture should be carefully tied to appose all layers of the intestine and the knots should be located extraluminally. Here a simple continuous suture pattern is used. *Note that pulling a simple continuous suture too tight will result in a purse string effect which is not desireable as it may compromise the intestinal lumen diameter, further resulting in obstruction or stenosis. STEP 10 - Place a simple interrupted suture at mesenteric to appose intestinal ends. Mesenteric fat be be removed if necessary to properly visualize and place the suture., STEP 4 - With a simple interrupted suture, double ligate and transect the arcadial mesenteric vessels from cranial mesenteric artery which supplies the segment/section of intestine which is to be removed. Following this, also double ligate terminal arcade vessels within mesenteric fatat the points of proposed intestinal transection STEP 5 - Chyle from the lumen must be gently milked out from the segment of intestine to be transected and the lumen is to be occluded at both ends of the segment in order to minimize leakage of the intestinal contents