General surgery

This chapter covers topics a surgical trainee will find useful. Preoperative assessment covers ASA Grades, NICE guidance, cardiopulmonary exercise testing (CPEX), P-POSSUM. Preoperative medication review covers medications to continue, and medications to be stopped. Consent details test of materiality, Montgomery vs Lanarkshire Health Board, adults who lack capacity, best interests, Advanced Directive, Living Will, Lasting Power of Attorney, Independent Mental Capacity Advocate (IMCA), Gillick Competency, delegation of consent, and consent forms. Surgical site infections (SSIs), NICE guideline on antibiotic prophylaxis, and venous thromboembolism (VTE). The WHO surgery checklist explains team brief, sign in, time out, sign out, debrief. Types of skin preparation—chlorhexadine, betadine. Absorbable, non-absorbable sutures, synthetic, biological meshes. Enhanced recovery, day surgery. Diathermy, ultrasound devices, lasers. Duty of candour. Open and close midline laparotomy incision, induction of pneumoperitoneum, diagnostic laparoscopy. Lichtenstein, totally extraperitoneal (TEP), transabdominal preperitoneal (TAPP), Lockwood, Lothiesen, McEvedy femoral hernia repair, ventral and incisional hernia repair, excision biopsy, abscess incision and drainage, ingrowing toenails.