Janatzai General Surgery and Dental CLinic

09/05/2026

Shout out to my newest followers! Excited to have you onboard! Nur Premi, Said Mohammad Totakhil, Dr-Abdul Hadi Arabzai Chopan, Royal Sultan, Zarif Serqikhil, Khan Ahmadzai, Danish Afghan, Zakir Ullah Ghazi, Najeeb Khawreen, سيدکبير خاموش, Mirwias Taheri, Salimullah Mohammadi, بلال احمد همدرد, Ahmad Jan Ahmadi, Abdulghaffar Adil, عطا محمد شریفی, Faqirullah Faiq, Aziz Khan, Miwadin MaSoom

26/04/2026

26/04/2026

This operative guide details the procedure for a Total Abdominal Hysterectomy (TAH). For general surgeons, the emphasis is on the systematic identification of the ureter and the secure ligation of the vascular pedicles.
​1. Patient Positioning & Preparation
​Position: Supine or low lithotomy (if va**nal access is needed for a manipulator).
​Anesthesia: General endotracheal anesthesia with neuromuscular blockade.
​Preparation: Catheterize the bladder to decompress it and reduce the risk of cystotomy. Ensure the va**na is prepped if a total hysterectomy is planned.
​2. Incision & Entry
​Choice of Incision: * Pfannenstiel: Generally preferred for cosmesis and lower hernia risk.
​Midline Laparotomy: Preferred for large uteri (>16 weeks size), suspected malignancy, or extensive adhesions.
​Exploration: Upon entry, perform a systematic sweep of the upper abdomen (liver, diaphragm, omentum) and pelvis.
​3. Key Anatomical Landmarks
​Identifying these structures is critical to prevent "preventable" injuries:
​The Ureters: Found crossing the iliac artery bifurcation and running medial to the infundibulopelvic (IP) ligament.
​The "Water Under the Bridge": The ureter passes deep to the uterine artery near the level of the internal os.
​The Round Ligaments: The primary lateral anchors.
​The Bladder Flap: The vesicouterine peritoneum.
​4. Critical Surgical Steps
​Step A: Developing the Retroperitoneum
​Divide the round ligaments bilaterally using cautery or suture ligation.
​Incise the anterior leaf of the broad ligament toward the bladder flap and the posterior leaf toward the IP ligaments.
​Ureter Identification: Use blunt dissection to identify the ureter on the medial leaf of the broad ligament. Always visualize the ureter before ligating the IP ligament.
​Step B: Adnexal Management
​Salpingo-oophorectomy: Clamp, cut, and double-ligate the IP ligaments (containing the ovarian vessels).
​Ovarian Preservation: Clamp and ligate the utero-ovarian ligaments and fallopian tubes.
​Step C: Mobilizing the Bladder
​Pick up the vesicouterine peritoneum and incise it transversely.
​Use sharp and blunt dissection to push the bladder inferiorly off the lower uterine segment and cervix. This "drops" the ureters laterally.
​Step D: Ligation of Uterine Vessels
​Skeletonize the uterine arteries at the level of the internal os.
​Place a Heaney or Ballantine clamp perpendicular to the uterus.
​Cut and secure with a transfixion suture.
​Step E: Parametrial Dissection & Colpotomy
​Ligate the cardinal and uterosacral ligaments.
​Once the cervix is palpated, perform a circumferential incision at the va**nal vault (colpotomy).
​Remove the specimen and immediately place an "Angle Stitch" at the lateral va**nal cuff to incorporate the cardinal/uterosacral complexes for support.
Postoperative Care
​Pain Management: Multimodal analgesia (NSAIDs, Acetaminophen, and limited opioids).
​Mobilization: Early ambulation (post-op day 0 or 1) to reduce VTE risk.
​Voiding: Remove the Foley catheter within 24 hours unless extensive bladder dissection was required.
​Diet: Advance to clear liquids/regular diet as tolerated; routine "waiting for flatus" is no longer standard in ERAS (Enhanced Recovery After Surgery) protocols.

26/04/2026

د اپنډيکس د التهاب نښې نښانې په دياګرام کې په لنډ ډول ښودل شي دي.

26/04/2026

د اپنډيکس اناتوميک دياګرام

Check out ✅پوهندوی دوکتور خوشحال جنت زی’s post.

26/04/2026

د بواسير دياګرام ښودنه

Check out ✅پوهندوی دوکتور خوشحال جنت زی’s post.

18/04/2026

د تخمدان دانې دومره هم غټیدلی شي .

په لاندی انځور کې د تخمدان یوه دانه چې 8kg وزن او د اتو لیترو په شاو خوا کې مایع هم درلوده د همدې زیات وزن او حجم له امله یې ناروغ تنفسي ستونزه پیداکړي وه او ساه یې نشوه اخیستلای نوموړي دانه د 60 کلنې ښځې په تخمدان پورې تړلي وه د ډاکټرانو لخوا زیاتره د کنسر په احتمال او د عملیاتو له امله د مړینې زیات چانس درلودلو په وجه کور ته رخصت شوی وو د ډاکټر خوشحال جنت زي لخوا دانه په مکمله توګه وویستل شوه او اوس نو بیا درې کاله کیږي ناروغ خپل نورمال ژوند ته ادامه ورکوي

08/04/2026

نن ورځ دوه عملیاتونه په بریالیتوب سره تر سره شول