TOPIC 8. BASIC SURGICAL PROCEDURES – INCISION, EXCISION, -TOMY AND STOMA
1. Incision
An incision is a deliberate cut through tissue to gain access, release pressure, drain a collection or expose an anatomical structure. The site, direction and length are selected to provide adequate access while respecting skin tension lines, vessels, nerves and underlying anatomy.
- Common examples: laparotomy, thoracotomy, incision and drainage of an abscess, and skin incision for biopsy or device insertion.
- Principles: adequate exposure, sharp controlled cutting, tissue-plane awareness, haemostasis, protection of adjacent structures and appropriate closure.
- Complications: bleeding, infection, injury to underlying organs, poor scar, wound dehiscence and incisional hernia.
2. Excision
Excision is removal of a tissue, lesion or organ, usually by cutting around it. It may be diagnostic (excisional biopsy) or therapeutic (removal of a tumour, cyst or diseased tissue).
- Plan margins and anatomical planes according to pathology and oncological principles.
- Handle specimens carefully; orient and label them for histopathology when required.
- Potential complications include bleeding, infection, injury to adjacent structures, functional loss and recurrence if disease is incompletely removed.
3. Common suffixes
4. Stoma
A stoma is a surgically created opening between an internal organ and the body surface, or between two hollow structures. It may divert contents, decompress an organ or provide access.
Examples: colostomy, ileostomy, urostomy and tracheostomy.
Temporary stoma: diverts faeces or urine to protect a distal anastomosis or allow healing; may later be reversed.
Permanent stoma: created when restoration of normal continuity is not possible or appropriate.
Basic care: assess colour and viability, output, mucocutaneous junction, peristomal skin, appliance fit, hydration and patient education.
Complications: ischaemia/necrosis, retraction, prolapse, stenosis, parastomal hernia, high output (especially ileostomy), skin irritation, obstruction and dehydration.
Terminology trap: -tomy means cutting into; -ectomy means removal; -ostomy means creating an opening. These suffixes are not interchangeable.