Topics of the lesson. Surgical accesses to the abdominal organs. Revision of the abdominal cavity with penetrating wounds of the abdomen. Features resection of the small and large intestine. Types of intestinal fistula. The imposition of fecal fistula and artificial anus. Appendectomy: types, stages. Methods duodenum stump suturing. Laparoscopic methods for removal of the appendix. Surgical treatment of acute intestinal obstruction. Removal of Meckel's diverticulum.
19.1. What is a revision of the abdominal cavity?_
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What are the indications to the abdominal revision?__
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19.2. Describe abdominal cavity revision stages. 1. Choice of surgical access:__
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19.3. Draw in the Fig. 19.1 the point of projection of the appendix and surgical access for appendectomy.
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Fig. 19.1. Surgical access to the appendix according to Volkovych-Dyakonov
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19.4. Sign the steps of the appendix removal surgery shown in Fig. 19.2. Describe two main types of this operation.
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Fig. 19.2. Stages of appendectomy 1. __
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19.5. Describe the stages of the formation of artificial anus according to the method of Maydl, presented in Fig. 19.3.
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Fig. 19.3. The stages of putting in an artificial anus according to the method of Maydl 1. __
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What is a «spur»?__
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19.6. What operations on the colon and rectum are presented in Fig. 19.4? 1. __
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Name the indication for these operations__
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Fig. 19.4. The scheme of the surgery of colon and rectum
19.7. Explain the situation in this clinical case. Use Figs. 19.5 and 19.6.
While performing the surgical access by Pfannenstiel, the horizontal incision of the superficial tissues and the aponeurosis of the rectus abdominis muscles is performed just above the pubic symphysis. Then the white line is cut longitudinally, the rectus abdominis muscles are retracted laterally, the transverse fascia and peritoneum are cut along the midline. During this approach it is necessary to avoid the damage of the nerves running between the internal oblique and external oblique abdominis muscles along the lateral margins of the rectus abdominis muscles. What are these nerves?