General Surgery

Shared operative foundations taught once, the room they happen in, the instruments on the tray, and the anaesthetic that makes it possible.

• The acute abdomen method

  Every general surgical emergency passes through the same funnel. Learn the funnel once and appendicitis, obstruction and perforation become variations, not separate subjects.

  1. 01Sick or not sick. The end-of-the-bed test, then vitals: peritonitis and shock announce themselves before any scan.
  2. 02Resuscitate in parallel. Fluids, analgesia, antiemetics, cultures and antibiotics where sepsis is declared: treatment does not wait for diagnosis.
  3. 03Localise the story. Where it started, where it moved, what it does with food and movement: the history places the organ.
  4. 04Examine for the trump cards. Guarding, rigidity, and the hernial orifices every single time: peritonism changes the pathway.
  5. 05Image the question. Ultrasound for the RUQ and the pelvis, CT for almost everything else: order the scan that answers the theatre question.
  6. 06Decide, and write the plan. Theatre, active observation with exit criteria, or discharge with safety-netting: every abdomen leaves with one of the three.

  Used byOpen appendectomyEmergency laparotomySmall bowel resection & anastomosis

• The anastomosis & why it leaks

  Joining bowel is the specialty's signature act, and the leak is its signature fear. The principles are shared by every resection, so they are taught once here.

  1. 01Blood supply. An anastomosis heals on perfusion: bowel ends are cut back to bleeding tissue, and tension is the enemy of both.
  2. 02Technique. Stapled or sewn matters less than the principles both serve: apposition, perfusion, no tension, no sepsis.
  3. 03The patient's half. Nutrition, steroids, smoking, diabetes and shock all vote on healing; the operation only casts one ballot.
  4. 04The leak's timetable. POD 5 to 7 is the classic window: a new tachycardia, a new AF, or a patient who fails to progress is a leak until proven otherwise.
  5. 05What follows. Contained leaks may drain; free leaks return to theatre for washout and usually a stoma: control the sepsis first.

  Used bySmall bowel resection & anastomosisEmergency laparotomy

• Watch

  Operative steps: open appendectomy

  A short operative walk through the muscle-splitting approach, delivery of the appendix and the stump.

  Watch for

  • The grid-iron incision and each layer split along its fibres
  • Following the taeniae to the base
  • Ligating the mesoappendix before the stump

  Source: Pediatric Surgery Operative · Watch on YouTube

• Available externally

  The Critical View of Safety: what it is and why we do it

  The society that wrote the safe-cholecystectomy program, teaching its central idea.

  This source plays on its own site · SAGES Video Library

• Watch

  Bail-out strategies for the difficult laparoscopic cholecystectomy

  What to do when the critical view will not come: subtotal, fundus-first, or stop.

  Watch for

  • The point at which dissection stops being safe
  • Fenestrating versus reconstituting subtotal cholecystectomy
  • Why conversion is not failure

  Source: SAGES · Watch on YouTube
• Watch

  Ileocolic bowel resection with primary anastomosis

  A peer-reviewed protocol preview: mobilisation, division and a stapled anastomosis.

  Watch for

  • Judging bowel viability before you commit
  • Mesenteric division and the marginal blood supply
  • Closing the mesenteric defect

  Source: JoVE, Journal of Visualized Experiments · Watch on YouTube
• Watch

  Lichtenstein repair of inguinal hernias, revisited

  The tension-free mesh repair as the society that teaches it describes the steps.

  Watch for

  • Opening the canal and finding the ilioinguinal nerve
  • Dealing with the sac
  • Mesh fixation and the new internal ring

  Source: Hernia Society of India · Watch on YouTube
• Watch

  Inguinal hernia repair

  The overview a patient hears: what a hernia is, and what open and laparoscopic repair do to it.

  Source: Cleveland Clinic Abu Dhabi · Watch on YouTube
• Watch

  Laparotomy closure

  Mass closure of the midline: suture length to wound length, bite size and spacing.

  Watch for

  • The 4:1 suture to wound length rule
  • Small bites, and why they hold better than big ones
  • What a burst abdomen looks like before it happens

  Source: Conceptual Orthopedics (Dr Jignesh Gandhi) · Watch on YouTube

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