1.

APPENDIX

Patient had come to the OPD with complains of pain in the right iliac fossa,
vomiting and anorexia for the last 1 day. On examination there was severe
tenderness in the right iliac fossa. Rebound tenderness was also positive.
Generalized guarding throughout the abdomen. His blood workup revealed
elevated TLC. A clinical diagnosis of acute appendicitis was made. Patient was
shifted to the OT.

Patient was placed in supine position. Patient was properly scrubbed and draped.
Gridiron incision was given. Skin, subcutaneous tissue and underlying structures
were incised. Peritoneal cavity opened. Teniae Coli identified, following them
appendix was identified. Mesoappendix was identified, ligated and cut. Appendix
was also than ligated and cut. Hemostasis secured and wound was closed in layers.

2. INGUINAL HERNIA

Patient had initially came to the OPD with complains of pain and swelling in the
right inguinal region for the last 2 years. On examination a reducible swelling was
present. Cough impulse was positive. It was not possible to go above the swelling.
A clinical diagnosis of inguinal hernia was made. It was decided that hernioplasty
of the patient should be done.

Patient was properly scrubbed and draped. A long oblique incision was given over
the inguinal ligament. Skin, subcutaneous tissue, campers and scarpas fascia were
divided in the line of the incision. External oblique aponeurois was divided to open
the inguinal canal. External oblique was separated from internal oblique. Cord was
lifted from the floor of the inguinal canal. Sac was identified. Sac was separated
from vas deferens and spermatic vessels. As the hernia was indirect, it was ligated
at the neck and remaining portion excised. Mesh was placed. Hemostasis secured.
Wound was closed in layers.
3. HYDROCELE

Patient had initially came to the OPD with complains of swelling in the left side of
the scrotum for the last 2 years. On examination a non-tender swelling was present
in the left side of the scrotum. The swelling was non reducible. Spermatic cord
could be palpated separately from the swelling. Trans illumination test was
positive. A clinical diagnosis of left sided hydrocele was made and it was decided
that the patient should be operated.

Patient was properly scrubbed and draped. Vertical incision was given along the
hydrocele. Skin, dartos muscle, external and internal spermatic fascia were incised
to expose the parietal layer of tunica vaginalis. Parietal layer of tunica was opened.
Fluid was sucked out. Opening was extended both upwards and downwards. Sac
was turned around cord structures. Turned edges of tunica were stitched posterior
to the cord. Testis was returned back to scrotum. Scrotum was stitched in two
layers

4. CHOLECYSTECTOMY

The patient had come to the OPD with complains of intermittent episodes of pain
in the right hypochondrium for the last 1 year. At the time of review in the OPD
the patient was pain free. Ultrasound examination of the patient showed the
presence of gall bladder stones. It was therefore decided that cholecystectomy of
the patient should be done.

Patient was properly scrubbed and draped. A subcostal incision was given. Skin
and subcutaneous tissue were incised. Anterior rectus sheath and muscle were
divided with diathermy. Peritoneal cavity was opened. Gallbladder was identified
and grasped with a sponge holding forceps. Cystic duct and artery were identified.
Cystic artery was ligated and cut following which cystic duct was also ligated and
cut. Fold of peritoneum attaching gallbladder with the liver was divided by
electrocoagulation. Gall bladder removed. Hemostasis was secured. Wound was
closed in layers.
5. CHEST TUBE INSERTION

The patient had been admitted by medical team as a case of liver cirrhosis. Chest
X-ray revealed massive pleural effusion in the right side. It was therefor decided to
insert a chest tube.

Patient was properly scrubbed and draped. Margins of triangle of safety were
identified. Local anesthesia was given. Incision was made. Skin and underlying
structures were incised. Pleural cavity was opened. A gush of fluid came outside
form it. Size 32 chest tube was inserted and attached with underwater seal.
Function ability of chest tube was confirmed by fluid column moving. Patient was
sent for check X-ray.

6. OPEN HEMORRHOIDECTOMY

Patient had come to the OPD with complains of bleeding per rectum and a mass
coming out of the anal opening which he had to manually reduce for the last 1
year. DRE and Proctoscopy was done. Internal hemorrhoids at 3 and 11 o clock
position were present. Based on history and examination a diagnosis of third
degree hemorrhoids at 3 and 11 o clock position was made. It was decided that
hemorrhoidectomy of the patient should be done.

Patient was placed in lithotomy position. Patient was properly scrubbed and
draped. Proctoscopy done. Hemorrhoids were pulled out. Pedicles of hemorrhoids
were exposed. Base was tied. Hemorrhoids were excised by electro cautery.
Hemostasis was secured. Pack was placed inside.

7. INCISION DRAINAGE OF GLUTEAL ABSCESS

Patient had come to the OPD with complains of high grade fever and severe pain in
the right buttock. On examination a warm tender swelling was present in the right
buttock. A diagnosis of gluteal abscess right side was done. It was decided to do
Incision drainage of the abscess.
Patient was properly scrubbed and draped. Using surgical blade 11 a deep incision
was made over the swelling. Approximately 50ml of pus was drained. Pus was sent
for culture and sensitivity. Pyodine soaked gauze was placed inside the wound.

8. ANAL FISSURE

Patient had come to the OPD with complains of bleeding per rectum and
intermittent episodes of constipation. On examination an anal fissure was present
at 6 o clock position. It was therefore decided to do left lateral sphincterotomy of
the patient.

Patient was placed in Lithotomy position. Properly scrubbed and draped. A blade
was inserted in between the internal and external sphincter at 3 o clock position.
Internal sphincter was incised.

9. BELOW KNEE AMPUTATION

The patient had come to the OPD as a case of diabetic foot. He was not properly
following dietary advice and medication for the management of his diabetes.
Amputation of big toe had already taken place. Deep seated skin infection was
present with multiple ulcers. Foul smelling discharge. X-ray revealed
osteomyelitis. It was therefore decided that below knee amputation should be done.

Patient was placed in lithotomy position. Tourniquet was applied. Patient was
properly scrubbed and draped. Incision was given over the leg 12 cm below the
tibial tuberosity with a long posterior skin flap. Underlying muscles were cut. Tibia
and fibula were transected. Posterior muscle mass was sharply dissected. Bleeding
vessels were identified and ligated. The two flaps were stitched together. Dressing
done.
10. REPAIR OF EPIGASTRIC HERNIA

The patient had initially came to the OPD with complains of a lump in the
epigastric region for the last 2 years. The Lump was reducible in nature. Cough
impulse was positive. Clinically a diagnosis of epigastric hernia was made. It was
therefore decided that repair of the epigastric hernia should take place.

Patient was placed in supine position. Properly scrubbed and draped. Transverse
incision was given. Hernia was dissected out from surrounding abdominal fat.
Opening in linea Alba was identified. Hernia sac was incised and contents reduced
into the abdomen. The neck of the hernia was ligated and the remaining sac
excised. Linea Alba was closed and a mesh was placed above it. Wound was
closed in layers.

11. REPAIR OF PERIUMBILICAL HERNIA

The patient had initially came to the OPD with complains of a lump in the
umbilical region for the last 2 years. The Lump was reducible in nature. Cough
impulse was positive. Clinically a diagnosis of periumbilical hernia was made. It
was therefore decided that repair of the periumbilical hernia should take place.

Patient was placed in supine position. Properly scrubbed and draped. Curved
transverse incision was given below the umbilicus. Hernia was dissected out from
surrounding abdominal fat. Opening in linea Alba was identified. Hernia sac was
incised and contents reduced into the abdomen. The neck of the hernia was ligated
and the remaining sac excised. Linea Alba was closed and a mesh was placed
above it. Wound was closed in layers.
12. [Link] OF INCISIONAL HERNIA

The patient had come to the OPD with complains of swelling in the right iliac
fossa. Patient gave history that he had been operated for acute appendicitis 30
years ago. The swelling had appeared 3 years ago at previous incision site and was
increasing in size. Swelling was reducible in nature and cough impulse was
positive. Diagnosis of incisional hernia was made and it was decided that patient
should be operated.

Patient was placed in supine position. Properly scrubbed and draped. Incision was
made over previous appendectomy scar. Hernia was dissected out from
surrounding abdominal fat. Sac was opened. Contents were reduced into peritoneal
cavity after freeing intestinal contents from sac. Excessive sac was excised.
Peritoneum was closed. Muscular defect stitched. Mesh placed. Hemostasis
secured and wound closed in layers.

12. [Link] OF INCISIONAL HERNIA (Post caesarean)

The patient had come to the OPD with complains of swelling in abdomen. Patient
gave history that she had undergone a Caesarean section 3 years ago. The swelling
had appeared 3 years ago at previous incision site and was increasing in size.
Swelling was reducible in nature and cough impulse was positive. Diagnosis of
incisional hernia was made and it was decided that patient should be operated.

Patient was placed in supine position. Properly scrubbed and draped. Transverse
Incision was made in hypogastric region. Hernia was dissected out from
surrounding abdominal fat. Sac was opened. Contents were reduced into peritoneal
cavity after freeing intestinal contents from sac. Excessive sac was excised.
Peritoneum was closed. Muscular defect stitched. Mesh placed. Hemostasis
secured and wound closed in layers.
13. ANAL FISTULA

Patient had come to the OPD with complains of discharge of pus in perianal region
for the last 1 year. He had used multiple antibiotics without any improvement. On
DRE an external opening of an anal fistula was visualized at the anterior aspect of
the anal opening. No internal opening could be palpated. It was decided that the
patient should be operated.

Patient was placed in lithotomy position. Properly scrubbed and draped. A probe
was passed through external opening. It passed out through an internal opening.
The tract was laid open with a diathermy probe. Granulation tissue was curetted
away.

14. PILONIDAL SINUS EXCISION

The patient had come to the OPD with complains of sever itching and discharge in
between the upper gluteal folds for the last 3 months. On examination a pilonidal
sinus was visualized between the gluteal folds. It was therefore decided that the
patient be operated.

Patient was placed in prone position. Properly scrubbed and draped. An elliptical
incision was given around the pilonidal sinus. Sinus was completely excised.
Hemostasis secured. Wound was left open.
15. DEBRIDEMENT OF FOURNIERS GANGRENE

Patient had initially came to the emergency department with complains of

Patient was shifted to OT. Properly scrubbed and draped. Extensive debridement of
all dead and dying tissue was done. Pus filled pockets were opened. Pyodine
soaked gauzes were placed inside scrotum.

16. FEEDING JEJUNOSTOMY

Patient was already admitted in oncology dep’t as a case of Ca esophagus. Initially

After thorough investigating the patient and preparing him for surgery. Patient was
shifted to OT. Properly scrubbed and draped. Upper left sided transverse incision
was made. Skin and underlying structures incised. Peritoneal cavity opened. DJ
junction identified. Incision was made in jejunum. Foley`s catheter was passed
through opening in jejunum and secured. Hemostasis was secured and wound was
closed in layers.

17. MESENTERIC ISCHEMIA (Exploratory Laparotomy)

Patient had come to the OPD with the primary complains of severe abdominal pain
for the last 2 days. Pain had started spontaneously and had been increasing in
severity. Patient was also complaining of constipation for the last 2 days. On
examination there was severe tenderness of the abdomen. After various laboratory
and radiological studies it was decided to proceed with exploratory laparotomy.

Patient was shifted to OT. Properly scrubbed and draped. Midline incision was
given. Skin and underlying structures incised. Peritoneal cavity opened.
Underlying structures examined. Ischemic changes were present in the gut. All
dead tissue along with its blood supply was excised. End to end anastomosis was
made. Hemostasis was made and wound was closed in layers.

18. SUPRAPUBIC CATHETERIZATION

Patient had been suffering from intermittent episodes of urinary retention for the
last 3 years. Normally it was relieved by Foley’s catheterization. This time despite
3 attempts catheter could not be passed. It was therefore decided to proceed with
suprapubic catheterization.

Patient was shifted to minor OT. After initially passing trocar with great care into
bladder suprapubic catheterization was done.

19. DEBRIDEMENT OF DIABETIC FOOT

Patient had come to OPD with complains of multiple pus pockets and swelling in
right foot for last 5 days. Patient was unwilling for amputation. It was therefore
decided to proceed with extensive debridement. During the surgery all necrotic
tissue was excised. Pus pockets were opened. Pus was drained and Aseptic
dressing done.

20. EXCISION OF LIPOMA

Patient had come to the OPD with primary complain of a gradually increasing
swelling over the back for the last 5 years. FNAC of the swelling had already been
done and it showed features consistent with lipoma.

It was therefore decided that the mass be excised. Patient was shifted to OT.
Properly scrubbed and draped. Transverse incision was given over the lump.
Lipoma was separated from underlying tissues by a combination of sharp and dull
dissection. Lipoma was completely excised. Hemostasis was secured and wound
was closed.
21. CIRCUMCISION

The child was bought to the OPD by mother. They wanted that circumcision of the
child be done for ritual purpose. After basic investigations it was decided that
circumcision be done under General Anesthesia.

Child was shifted to OT. Properly scrubbed and draped. The coronal grove was
identified. The foreskin was replaced in its normal position. A cut was made in the
ventral surface of foreskin. A second slit is made on the underside of the penis. The
foreskin was cut away around the rim of the coronal groove. The foreskin was cut
away around the rim of the coronal groove. The edges of the foreskin were
stitched.