ILEOSTOMY varsha IIIrd BPT

WHAT IS ILEOSTOMY ? It is an opening made between the small intestine and the abdominal wall usually by using distal ileum but sometimes more proximal to small intestine. Under GA An ileostomy, also known as an enterostomy, is a surgical procedure used to create an artificial exit for bodily waste when the lower portion of the digestive system is not functioning properly.enterostomy Can be created for either short- or long-term use, depending on the individual’s condition.

Short-term use of an enterostomy may be utilized when a partial removal of the small intestine is performed. long-term use of an enterostomy occurs when the entire lower portion of the digestive system, including the rectum, are removed. A short-term, or partial, enterostomy may be reversed within about three months of placement. When the ileostomy is no longer necessary, another surgical procedure is performed to reconnect the ends of the small intestine and restore proper digestive function.

Individuals who have an enterostomy procedure may be hospitalized for up to one week following surgery. Immediately following surgery, the individual will be placed on a diet of clear liquids, and over time thicker fluids are given. As functionality is restored to the bowel, the individual may be able to start eating soft foods within two days following surgery. Once the individual is able to consume a normal diet, she or he may experience changes in digestion.

Consuming some raw vegetables and high fiber foods may result in the formation of a blockage within the digestive tract and cause abdominal discomfort when passed through the stoma. Individuals who have had an enterostomy may also experience increased instances of diarrhea and gas that may subside over time. During the surgery, the rectum and colon are removed or bypassed. Waste products drain from the body through a stoma, a surgically created port created when the small intestines, or ileum, is brought through the abdominal wall. The method of clearing this waste depends on the type of ileostomy performed.

INDICATIONS Ulcerative colitis Inflamatory bowel disease Crohn’s disease Rectal or colonic cancers polyposis

END ILEOSTOMY Also know as Brook ileostomy. The end of the ileum is pulled through the abdominal wall to create the stoma. The stoma is typically placed on the lower right side of the abdomen. The patient has no control over waste output and must wear a collection pouch at all times. The waste contains digestive enzymes which can irritate skin, so it is important for the patient to protect the area around the stoma.

Temporary end ileostomy may be done as a staged procedure and later anastomosed to the colon or rectum as in inflamatory bowel disease,colonic trauma,complex colonic fistula

C ONTINENT ILEOSTOMY OR ABDOMINAL POUCH With a continent ileostomy, a pouch that collects waste is made from part of the small intestine. This pouch stays inside your body, and it connects to your stoma through a valve that your surgeon creates. The valve prevents the stool from constantly draining out, so that you usually do not need to wear a pouch. Waste is drained by putting a tube (catheter) through the stoma a few times each day.

L OOP ILEOSTOMY LOOP ILEOSTOMY As an alternative to colostomy when it is difficult. Advantage is that,the mesentric vessels are not divided in its construction so ischemia is less common. The amount of ileal protrusion above the skin level is limited

COMPLICATIONS Haemorrhage –from the mucosal vessels. Parastomal skin irritation –due to poor sealing or allergy to pouch materials. Paraileostomy ulceration –due to infection and avascular necrosis. Ileostomy obstrucyion –due to any adhesion Ileostomy fistula –due to suturing of bowel wall to rectal sheath. Stenosis Retraction Prolapse Hernia

HERNIAL REPAIR

What is hernia? A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the strong layer of the belly wall that surrounds the muscle.

hernioplasty Hernioplasty is a surgical procedure used for correcting a hernia. Recommended for inguinal herniashernia Open and laproscopically

procedure Conventional hernioplasty involves the administration of a single, long incision over the hernia. Depending on whether the hernia is bulging out or lying inward, it can either be pushed back or its sac tied off and removed.

When the hernia is pushed back into place, a mesh patch made from synthetic material is stitched over the weakened area in the abdominal wall as reinforcement. The patch works to decrease strain placed on the abdominal wall as well as to reduce the risk of recurrence

Average recovery following hernioplasty surgery takes three to four weeks with limited activity Materials used are: syntetic like dacron mesh. biological like tensor fascia lata. prolene is commonly used.

principle Size of the mesh should be bigger than size of defect. Mesh should be fixed above and belowusing non absorbable sutures. Absolute haemostasis and control of infection is important.

indications Direct hernia Recurrent hernia Incisional hernia Old age Hernia with weak abdominal muscle tone Sliding hernia

risks nerve damage infection bleeding at the incision site damage to the arteries or surrounding veins Mesh extrusion Foreign body reaction

herniorraphy herniorrhaphy is a procedure in which strengthining of the posterior wall of the inguinal canal either by repair or mesh is done. Herniorrhaphy is a specific treatment employed relative to the type of hernia problem that the patient is experiencing.

the patient may return home from the hospital on the same day of the operation. A herniorrhaphy procedure normally requires only the employment of a local anesthetic

procedure It is strengthening if the posterior wall of the inguinal canal using non absorbable monofilament sutures. It takes 6 months to achieve more than 80% of the tensile strength in repaired hernial wound and so non-absorbable suture material is used. Materials used: prolene ethylon

Gastrectomy is surgery to remove part or all of the stomach. If only part of the stomach is removed, it is called partial gastrectomy If the whole stomach is removed, it is called total gastrectomy

under general anesthesia The surgeon makes a cut in the abdomen and removes all or part of the stomach, depending on the reason for the procedure.general anesthesia Depending on what part of the stomach was removed, the intestine may need to be re-connected to the remaining stomach (partial gastrectomy) or to the esophagus (total gastrectomy).

Chronic benign gastric ulcers Benign gastric tumors Ca stomach Stomal ulcer Bleeding ulcer Gastric lymphoma polyps

Total gastrectomy – 100% End to end esophago-jejunostomy is done as reconstruction. indication - ca stomach

Subtotal gastrectomy – 85% End to side gastro-jejunostomy and duodenal stump closure BILLROTH II Indication – ca body of the stomach

Lower partial gastrectomy 1.End to end gastro-duodenostomy and duodenal stump closure BILLROTH II 2.End to end gastroduodenostomy BILLROTH I

Indications are – ca stomach- pylorus,antrum & first part of duodenum. Benign ulcer disease of gastro- duodenum

Kocherization of the duodenum after identifying the middle colic vessels. Mobilisation of the splenic flexure and release of omentum from the transverse colon. Later at the site of resection of the stomach hemostatic sutures are made. Gastric opening should be 2.5 to 3cm wide. End to end anastomosis is done with the duodenum.

Antrum is resected. Jejunum is identified. Gastro-jejunal anastomosis is constructed in two layers.

Intragastric haemorrhage from anastomotic area. Extragastric haemorrhage from injured adjacent organs. Gastric remnant necrosis. Intraabdominal abscess. Postopp pancreatitis Weight loss fistula

Pain Retention of secretions Peripheral muscle weakness Reduced air entry Unable to do ADL

Patient education ROM exs Airway clearence techniques Lung volume expansion therapy Splinted FET

LEVT ACT Early mobilisation Positioning Breathing exs

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