23 topics with concise reviews: definitions, key facts, and class questions.
This section covers the fundamentals of abdominal surgery: from the rules of laparotomy, paracentesis, and exploration of the abdominal cavity to complex resections and reconstructive interventions. This is the foundation required to master both emergency and elective operative surgery.
Here we examine in detail the technique of intestinal suturing and the formation of gastrointestinal anastomoses. Separate blocks cover operations on the stomach (resections, gastroenterostomy, closure of a perforated ulcer), small and large intestine (including appendectomy, sigmoid colon resection, and creation of artificial fistulas). Interventions on the hepatobiliary zone and parenchymal organs are covered in depth: cholecystectomy, choledochotomy, liver, pancreatic, and splenic surgery, as well as reliable methods of hemostasis.
During practical classes and exams, instructors traditionally emphasize the classification of intestinal sutures, the anatomical rationale for surgical approaches, and the strict sequence of steps in appendectomy and cholecystectomy. Pay special attention to the rules of organ exploration and umbilical vein catheterization — these are frequent "catch" questions on the module.
Why is the umbilicus bypassed specifically on the left side during a midline laparotomy?
This is necessary to preserve the integrity of the round ligament of the liver (lig. teres hepatis), which is located to the right and above the umbilical ring.
Why displace the skin before introducing the trocar?
This is necessary to create a tortuous wound tract in the soft tissues. This surgical technique serves as the main prevention of ascites fistula formation after instrument removal.
Which organs are explored first when blood is present in the abdominal cavity?
Parenchymatous organs—the liver, spleen, and pancreas—are examined first, as they are most often the source of massive hemorrhage.
What are the basic requirements for intestinal sutures?
Strict adherence to asepsis, meticulous hemostasis, minimal tissue trauma (especially to the mucosa and submucosa), and ensuring reliable airtightness.
Why does anastomotic leakage frequently occur after gastrectomy?
This is due to the fact that sutures are applied to the wall of the esophagus, which lacks a serosal covering (peritoneum). The absence of the peritoneum significantly impairs sealing and healing processes.
What is the difference between a fecal fistula and an artificial anus?
In a fecal fistula (fistula stercoralis), the contents exit both through the stoma and naturally through the anus. An artificial anus (anus praeternaturalis) completely bypasses the distal section, with all contents passing solely through the artificial opening.
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