Surgical operation in genaral surgary.

1. TBILISI STATE MEDICAL
UNIVERSITY
SURGICAL
OPERATION
Presented by Buddhike Wickramasinghe

2. Presentation
Breakdown
Important Points to Discuss
Types of Surgical operation
Principle stage of surgical operations
Preoperative period
Determination time of the operation
Character of Anesthesia
Character & Volume
Special preoperative measures
Intraoperative phase
types of sutures
instruments
Postoperative period
S U R G I C A L
O P E R A T I O N |
2 0 2 0

3. The greatest Wealth is
HEALTH.
Words of Wisdom
Lord Buddha

4. What is
surgical operation ?
mechanical influence on the organs and tissues
to cure and diagnostic.
S U R G I C A L
O P E R A T I O N |
2 0 2 0

5. TYPES OF
OPERATION
Elective Surgery
this type of surgery is optional, but
that’s not always the case. An elective
procedure is simply one that is planned
in advance,
Semi-elective Surgery
Semi-elective surgery is a surgery that
must be done to preserve the patient’s
life, but does not need to be performed
immediately.
Urgent Surgery
An urgent surgery is one that can wait
until the patient is medically stable, but
should generally be done today or
tomorrow
BASED ON TIMING
Emergency Surgery
An emergency surgery is one that must
be performed without delay; the patient
has no choice other than immediate
surgery, if they do not want to risk
permanent disability or death.
Orthopedic surgery
Cardiovascular Surgery
BASED ON BODY PART
Gynecology
Neurosurgery
Ophthalmology (Eyes)
Oral and Maxillofacial Surgery
Otolaryngology – (ENT)
Thoracic
Urology
Gastrointestinal surgery
Combined Operation
OTHER TYPES
stimulant Operation
Atypical Operation
Bloody and bloodless
One stage and multi stage
MAIN TYPES
Palliative operation
Radical operation

6. Radical
operation
ALSO CALLED RADICAL DISSECTION, IS SURGERY THAT IS MORE EXTENSIVE
THAN "CONSERVATIVE" SURGERY. IN SURGICAL ONCOLOGY, RADICAL
SURGERY IS SURGERY INTENDED TO REMOVE BOTH A TUMOR AND ANY
METASTASES THEREOF, FOR DIAGNOSTIC AND/OR TREATMENT PURPOSES.
S U R G I C A L
O P E R A T I O N |
2 0 2 0

7. Palliative
operation FOCUSES ON SUPPLYING THE GREATEST BENEFIT TO
THE PATIENT USING THE LEAST INVASIVE
INTERVENTION
IS SURGICAL INTERVENTION TARGETED TO MAKE A
PATIENT'S SYMPTOMS LESS SEVERE, THUS MAKE
THE PATIENT'S QUALITY OF LIFE BETTER DESPITE
NEGLIGIBLE IMPACT ON THE PATIENT'S SURVIVAL.
S U R G I C A L
O P E R A T I O N |
2 0 2 0

8. ONE STAGE
OPERATION
ABOUT
allsurgicalcurativeactionsaredoneatone
andthesametime,duringoneoperation
MULTISTAGE
OPERATION
AND
operationmeansdividingtheoperationin
stages,separatedintimefromeachother.
STIMULANT
OPERATION
AND
includeoperativeinterventionsforvarious
diseases
COMBINED
OPERATION
ABOUT
includethe operations,performedonthetwo
ormoreneighbouringorgansinvolvedinone
andthesamepathological process.

9. PRINCIPLE
STAGES
of surgical operations
The main
2.
PRINCIPLE STAGE OF
OPERATION
(surgical intervention)
3.
SUTURING OF TISSUES
AND WOUND.
1.
OPERATIVE ACCESS
(operative approach)

10. 01
To make a diagnosis;
02
To determine indications, time
and type of operation
03
To get the patient fit for the
surgical treatment
SARTTING OF OPERATION
Preoperative period
one step clouser to the well being
Pr-operative period is the time from the
patient’s admission to the surgical
department up to the beginning of the
operation.

11. D E T E R M I N A T I O N O F
The Timeof operation.
The time of operation is determined with
the indications for the operation
R E L A T I V E I N D I C A T I O N
may exist in the situations, which aren’t dangerous for the life
of the patient. Those operations may be performed as
planned operations and there is enough time to estimate the
contraindications for the operation by the help of therapeutic,
neurologist, endocrinologist, cardiologist.
01
Vital (indicatio vitalis) in case of so-
called life-saving operations;
02
Absolute indications;
03
Relative indications;
V I T A L I N D I C A T I O N S
for the life-saving (urgent) operations appear in the cases,
when the delaying of the operation is dangerous for the life of
the patient
A B S O L U T E I N D I C A T I O N S
occurs in cases, when delaying of the emergency operation for
the long time, causes the dangerous state for the life of the
patient.

12. E S T I M A T I O N O F ,
C H A R A C T E R O F
A N E S T H E S I A
1 Local anesthesia
potentialized anesthesia - 0.5b
2
Regional, spinal, epidural, intravenous
anesthesia, inhalation mask narcosis with
spontaneous breathing
3Standard combined endotracheal narcosis
4Combined endotracheal anesthesia with artificial hypothermia
artificial controlled hypotension, massive infusion therapy, electrocardiostimulation
5Combined endotracheal anesthesia with artificial blood circulation
hyperbaric oxygenation, intensive care and resuscitation

13. CHARACTER
AND VOLUMEOF THE OPERATION
ESTIMATION OF THE
01 Operations on the surface of body and minor
purulent surgery
0.5b
02 More difficult operations on the surface of the
body, internal organs, vertebral column,
peripheral nerves and vessels
01.b
03 Long and extensive (vast) operations on the
internal organs,
1.5b
04 Difficult operations on the heart, mistral blood
vessels, combined oncology, repeated and
reconstructive operations
02b
05 Difficult operations on the heart with the use of
artificial blood circulation apparatus,
transplantation of internal organs
02b

14. Special preoperative
measuresIN SURGGICAL OPERATION
O P E R A T I O N O N T H E L A R G E
B O W E L :
sparing (remnantless) dietary menu,
purgative drugs, cleansing enema (clyster)
P Y L O R O S T E N O S I S :
evacuation of gastric content by the help of
nasogastric tube and stomach lavage with sodium
bicarbonate sol., or diluted sol. of saline acid
P U R U L E N T D I S E A S E S O F
T H E L U N G S :
sanation of bronchial lumen with antibiotics,
antiseptic solutions and intratracheal,
endobronchial insertion through the catheter or
bronchoscopic technique
C H R O N I C O S T E O M Y E L I T I S :
lavage of purulent cavities and fistulas, sequestral
boxes with the solutions of antibacterial and
proteolytic enzymes.

15. extends from the time the client is admitted to the operating
room, to the time of anesthesia administration, performance
of the surgical procedure and until the client is transported to
the recovery room or postanesthesia care unit (PACU)
Definition.
Intraoperative
phase

16. Types of
suturesI N S U R G I C A L O P E R A T I O N S
ALBER’S, WOLFLER’S, CZHERNY’S,
SCHMIEDEN’S INTESTINAL SUTURE
“DANGER”
intestinal suture-through (via) all
layers
CONTINUOUS
INTESTINAL SUTURE
LOCK STITCH
Reverdin’s loop
“SAFE”
intestinal suture-sero-serous
(sero-muscular,Lambert’s) suture

17. Surgery is often considered to be largely about exposure multitude of
re-tractors exist to aid in exposing the bodies cavities accessed
during surgery
These can broadly be hand held (often by a junior assistant) or self
retaining
Cutting and dissecting instruments:
Scalpels, scissors, and saws
diathermy/cautery
Grasping or holding instruments
forceps and clamps
forceps can be divided in traumatic and atraumatic
Hemostatic instruments:
instruments utilized for the cessation of bleeding
Artery forceps are a classic example in which bleeding is halted by
direct clamping of a vessel,
Sutures are often used, aided by a needle holder
Re-tractors:
is a tool or device for performing specific actions or
carrying out desired effects during a surgery or
operation, such as modifying biological tissue, or to
provide access for viewing it.
SURGICAL
INSTRUMENTS
THE
S U R G I C A L
O P E R A T I O N |
2 0 2 0

18. POSTOPERATIVE
PERIODit is the time from the finishing of the operation
till the recovery of patient
01 Early postoperative period
time from the finishing of the operation until the
discharge of the patient
02
Late postoperative period
time after discharging of the patient from the
hospital up to recovery or patient’s disability.
METABOLIC
STAGES:
1
Phase of catabolism
3-7 days and its most important signs are:
activation of simpatico-adrenal system,
hypothalamus. Hypoxia of the tissues causes
the metabolic acidosis.
case of absence of nutrition patient loses 250-
400g of proteins per 10 days
2
Phase reconstruction
lasts for 4-6 days. Catabolic phase transforms into
anabolism not at once, but gradually.
Positive nitrogen balance, decrease of potassium
loss with the urine, activation of parasympathetic
system.
insulin and androgens are significant in this phase
as disappearance of pain, normalization of
temperature, good appetite.
3
Anabolic phase
The most important markers of this period are
enhanced synthesis of proteins, glycogen and
fats
Body mass increases in 3-4 weeks.

19. Thank you for listening!
BUDDHIKE WICKRAMASINGHE