84 o Surgicot Procedures

lncluding Minimol Access Procedures

Abdomlnol Extrqintestinol Surgery

85

pancreas may remain and be attached to the duodenum along with the cornmon bile duct'

Procedure is A transverse, midline, or right param-edian incision

matle. The abdomen is explored' If total pancreatectomy i. to U" performed, see Pancreaticoduodenectomy' pp' iil:iilf""tv the distal portion of the pancreas is re-

or transperitoneally. The abscess is identified and cultures are taken. The abscess is evacuated and may be irrigated with an antibiotic solution. Drains are placed. lbe wound is closed in layers.

Preporotion of Potient
The patient is supine; arms may be extended on armboards for an,upper midline or subcostal approach. For a posterolateral approach, the patient is in the lateral position with the right side uppermost. The left arm is extended on an armboard; the right arm is supported by a Mayo stand padded with a pillow (or a double armboard may be used). The left leg is extended, and the right leg is flexed with a pillow between the legs and padding around the feet and ankles. Position is secured by wide adhesive tape from the shoulders, hips, and legs to the table. Apply electrosurgical dispersive pad.
Skin Preporotion

from ;";;,h;;ncreas is mobilized bv dissecting it gland transsecting the o."*L"o". vascular attachment.s, of the ;;il;;ppt"pt{9 n"i"t, and the proximal portion site is The operative Dancreas remarnlng ,. o'"erce*"' l.""ifv drained. The wound is closed in layers' Preoorotion of the Potient, Skin Preoorotion, DroPing, EquiPment, inJtl'umentotion.'suppties, ond Speciol
Notes

See Pancreaticoduodenectomy (Whipple Procedure)'

pp. 82-83. DRAINAGE OF ABSCESS(ES) lN rHE REGION OF THE LIVER

Definition Evacuation of purulent material

space

ing from axilla to just above the pubic symphysis, and down to the table at the sides. For a posterolateral approach, begin at the incision (eighth interspace) extending from the shoulder to the iliac crest and down to the table anteriqrly and posteconfined

For a subcostal approach, begin at the incision extend-

within a

riorly.

in or about the liver'

Droping Folded towels and a laparotomy or transverse sheet

(depending on incision)

Discussion

sonogram' The location of the abscess is determined by

;", or other x-ray study' A radiologist,may aspidrain the abscess percutaneously' If percuta;;ffi is ;;;;il;il;!e -rtt" inadequ^te, op"n su^rgical drainage are-classified as left and ;;;I"il;. "tt."ttes subhepatic' and intraheor ."Uai"phragrratic, "igit Mrrttiple abscesses ma)t be present' piti..
CT Procedure
exAn incision is made posteriorly along the twelfth rib

Equipment Electrosurgical unit

Suction li

ffirumentotion
Major procedures tray Iong instruments tray

il;;;il;;".lly,

or anteriorlv, either extraperitoneallv

Biliary tract tray (available) Earrington retractor