Dr Qamar Shahzad Joia General Surgeon

07/08/2025

ABG,s interpretation 6 steps

07/08/2025

Ischemia vs Necrosis vs Gangrene
Acute Limb Ischemia

07/08/2025

ILEAL CONDUIT FOR URINARY DIVERSION:
•In the event of a radical cystectomy for bladder cancer, appropriate urinary drainage will need to be constructed. The ureters have been previously identified in the retroperitoneum, followed into the pelvis & transected (see Fig. 8.4). Identify the terminal ileum and preserve 15-20 cm of the terminal ileum to avoid metabolic complications of malabsorption. A section of bowel 12-18 cm proximal to that is selected and isolated. Continue mobilization into the mesentery preserving blood supply to this segment (Fig. 8.8A). An ileoileostomy is performed usually side to side with sutures or staples taking care to preserve the bowel vascular supply. The anastomosis should be performed to allow the isolated segment of bowel to freely come to the anterior abdominal wall without compromise. Close the mesenteric defect to avoid internal herniation and obstruction (Fig. 8.8B).
•The ureters are prepared by spatulating the end of each ureter (Fig. 8.9A). The ureters are joined together with a single layer of running or interrupted suture (Fig. 8.9B). The back wall of the ureters is now approximated to the back wall of the intestine (Fig. 8.9C). Completion of the anastomosis to the bowel is demonstrated (Fig. 8.9D).
•Take care to provide a mucosa to mucosa watertight anastomosis reinforced with sutures in the muscular layer. The ileum can be anchored to the posterior abdominal wall to.avoid tension on the ureteroileal anastomosis. The ileal conduit is finished by bringing out the bowel through the right lower quadrant and maturing the stoma. As an alternative,each ureteroileal anastomosis may be done separately.
𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗛𝗶𝗴𝗵𝗹𝗶𝗴𝗵𝘁𝘀:
•A 𝗴𝗲𝗻𝗲𝗿𝗮𝗹 𝘀𝘂𝗿𝗴𝗲𝗼𝗻 might find himself/herself involved with the urologic service to assist in this procedure. Operative urinary continuity is good for any general surgeon to understand in practice.
•Many urologists will have other methods of handling the ureteral anastomosis to the bowel.
•A drain and temporary ureteral stent may be appropriate to avoid the postoperative development of a urinoma.
•Remember to not disturb the final 15-20 cm of native ileum to avoid problems of malabsorption unique to this section of small intestine.
•Orthotopic urinary diversion utilizing an ileal reservoir and the native urethra is an alternative for continent urinary diversion. This technique provides urinary continence in those patients whose urethral margins are negative by frozen section.
𝗥𝗲𝗳:SURGICAL ANATOMY FOR MASTERY OF OPEN OPERATIONS, 2020.

30/07/2025

STUMBL Score; Ribs Fracture/Blunt Chest wall trauma.

30/07/2025

# **Liver segments >>how to remember **
**by right hand **
* your 1st finger >>>is the 1st lobe >>>is the caudate
* hepatic veins divide the hepatic segments longitudinally
* portal vein divides the hepatic segments transversely.
..
upper segments (2/4/8/7)
remember it 2x4 = 8 and 7up
lower segments (3/4/5/6)
remember it by following numbers from 3 to 6

28/07/2025

Scoring systems to predict outcomes of laparotomy.

24/07/2025

Parkland Grading Scale system is a reliable intra-operative grading system to assess the difficulty in laparoscopic cholecystectomy and helps the surgeon to change the strategy of surgery.

02/07/2025

02/07/2025

BREAKING BAD NEWS
Steps how to break bad news to patient and relative of the patient

14/05/2025

Understanding about Fluids

14/05/2025

Medicine Dosage calculations